CMS Releases Final Rule Limiting the Duration of Non-Random Prepayment Complex Medical Review


Relief is on the horizon for some providers and suppliers under intense scrutiny by Medicare contractors. CMS has released a final rule establishing the bases for termination of non-random prepayment complex medical review, a process

that imposes significant documentation requirements on subject providers and suppliers. Under the new rule, a contractor must terminate complex medical review one calendar year after initiating such review, and must terminate the review earlier if the subject meets an error-rate benchmark.

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