Medicare Program Integrity Manual
Links to all Chapters and Exhibits.
The Internet-only Manuals (IOMs) are a replica of the Agency’s official record copy. They are CMS’ program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use the IOMs to administer CMS programs.
Use the links below for direct access to these PDF files:
Chapter 1 – Overview of Medical Review (MR) and Benefit Integrity (BI) Programs [PDF, 177 KB]
Chapter 2 – Data Analysis [PDF, 76 KB]
Chapter 3 – Verifying Potential Errors and Taking Corrective Actions [PDF, 471 KB]
Chapter 4 – Benefit Integrity [PDF, 674 KB]
Chapter 5 – Items and Services Having Special DME Review Considerations [PDF, 276 KB]
Chapter 6 – Intermediary MR Guidelines for Specific Services [PDF, 133 KB]
Chapter 7 – MR Reports [PDF, 202 KB]
Chapter 8 – Administrative Actions and Statistical Sampling for Overpayment Estimates [PDF, 121 KB]
Chapter 9 – Reserved for Future Use [PDF, 30 KB]
Chapter 10 – Reserved for Future Use
Chapter 11 – Fiscal Administration [PDF, 67 KB]
Chapter 12 – The Comprehensive Error Rate Testing Program [PDF, 58 KB]
Chapter 13 – Local Coverage Determinations [PDF, 131 KB]
Chapter 14 – Reserved for Future Use
Link to all CMS IOMs
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