When CMS needed to report Medicare Part C payment accuracy to Congress, it turned to a process built on precision, expertise and insight.
The Challenge
Every year, the Centers for Medicare & Medicaid Services (CMS) must report how accurately it pays out Medicare Part C benefits – a requirement under the Payment Integrity Information Act of 2019. The goal: to detect and reduce improper payments due to fraud, waste and abuse. Without a reliable system to calculate and report the Part C Improper Payment Measure (IPM), CMS could not demonstrate compliance to Congress or assess the effectiveness of its payment systems. The challenge was massive: process up to 7,000 medical records annually; provide accurate reporting; and deliver actionable insights – on time and within strict federal mandates.
Our Solution
RELI Group partnered with CMS’ Office of Financial Management to manage and support the Medicare Part C IPM effort. We developed a comprehensive approach that not only ensures compliance with federal requirements but also delivers valuable data-driven insights.
Our team processes thousands of medical records per payment year through meticulous validation workflows, feeding into the critical Part C Error Estimate. Beyond record handling, we support every operational component, including reporting, planning, training, CMS communications and policy tracking. RELI also leads ad hoc studies, conducts medical record reviews and follows CMS security best practices.
But we do more than tick boxes. Our work directly supports CMS’ mission to improve payment accuracy by identifying trends, patterns and problem areas. We translate raw data into recommendations, identifying payment errors and root causes for error rate reporting and corrective action plans. And our efforts impact real lives – safeguarding the integrity of services millions of Americans rely on.
Real Impact
Thanks to RELI’s work, CMS has a clear and consistent measure of how effectively it’s managing Medicare Part C payments. The insights we provide guide strategic decisions, inform policy improvements and ultimately protect taxpayer dollars.
Without this measure, CMS would lose one of its key tools for program oversight – leaving gaps in accountability, increasing the risk of unchecked fraud and undermining public trust. RELI helps ensure that doesn’t happen.
