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.
CMS FAQ: https://www.cms.gov/files/document/provider-burden-relief-faqs.pdf
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.