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CMS Announces Medical Reviews Starting August 3, 2020

CMS Announces Medical Reviews Starting August 3, 2020 July 27, 2020

CMS announced through an FAQ that it will resume its Fee-For-Service (FFS) medical reviews that were previously suspended due to the COVID crisis.  On August 3, both pre-payment medical reviews performed by Medicare Administrative Contractors (MACs) and post-payment reviews performed by the MACs, Supplemental Medical Review Contractor (SMRC) and Recovery Audit Contractors (RACs) will resume regardless of the status of the public health emergency. 

CMS recommends discussing any COVID-19 hardships with your contractor that might affect response timeliness, should you be selected for review.  CMS will conduct the reviews in accordance with statutory and regulatory provisions, as well as related billing and coding requirements, but will appropriately apply any waivers and/or flexibilities that were in effect on the dates of service in question. 

We recommend advising staff of this change to ensure they are prepared and any review requests are routed to the appropriate person to avoid any unnecessary delays in response.


HBE’s team of coding and compliance experts is available to assist you with external reviews of your documentation, coding and reimbursement as well as providing customized education and training for your staff. We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.

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