CMS Pub. 100-09, ch. 6, § 20

The primary goal of the POE program is to give Medicare providers the timely and accurate

information they need to understand the Medicare Program, stay informed about changes, and

correctly bill. POE educates providers, their staff and billing agency representatives about

Medicare Program fundamentals, national and local policies and procedures, new Medicare

initiatives, significant program changes, and issues identified through analyses of provider

inquiries, claim submission errors, MR data, Comprehensive Error Rate Testing (CERT) data,

and Recovery Auditor data.

MACs shall disseminate information to their providers and agencies representing the providers

through outreach, education, training, technical assistance, or other activities to help reduce

improper payments. Each MAC shall establish an improper payment outreach and education

program that will expand and enhance efforts to reduce improper payments in accordance with

guidance from CMS. MACs shall analyze data in accordance with sections 20.2 of this chapter

when developing their outreach and education program.

MACs shall give priority to improper payment outreach and education program activities that

address one or more of the following:

• Items and services with the highest rate of improper payment

• Items and services with the greatest total dollar amount of improper payments

• A clear misapplication or misinterpretation of Medicare policies

• Other types of errors that could be prevented through activities under the improper

payment outreach and education program

MACs shall also give priority to improper payment outreach and education program activities for

providers with the highest rate of improper payment and the greatest total dollar amount of

improper payments.

MACs have discretion to deliver education using the most effective and efficient strategy and method

to offer Medicare providers a broad spectrum of information about the Medicare Program. Clinical and

non-clinical staff may deliver POE education to groups or individuals through a variety of

communication channels and mechanisms—including Web, telephone, educational messages on the

inquiries line(s) and IVR, face-to-face instruction, web-based training, and presentations in classrooms

and other settings. We encourage innovation as MACs identify provider educational priorities and

delivery methods, including leveraging PCC and PSS resources to identify educational opportunities

and expand delivery methods.

MACs shall use all strategies and methods to inform and educate providers of

• the most frequent and expensive payment errors over the previous quarter

• specific instructions regarding how to correct or avoid such errors in the future

• notice of new topics approved for audits conducted by Recovery Auditors under section

1893(b)

• specific instructions to prevent future issues related to such new audits

• other information as determined appropriate by CMS

MACs shall use existing CMS educational products, including Medicare Learning Network®

(MLN) products or content whenever possible in educating providers. See section 20.3.1 of this

chapter.