CMS to Restart Medicare Audits Beginning August 3

Morgan Lewis - Health Law Scan

Morgan Lewis - Health Law Scan

The Centers for Medicare and Medicaid Services (CMS) recently announced that it intends to resume both prepayment and postpayment medical reviews conducted by the Medicare Administrative Contractors, Supplemental Medical Review Contractors, and Recovery Audit Contractors, including those under the Targeted Probe and Educate program, on August 3, 2020:

As states reopen, and given the importance of medical review activities to CMS’ program integrity efforts, CMS expects to discontinue exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency. (Emphasis added.)

CMS had suspended most Medicare audits and reviews as of March 30, 2020 due to the coronavirus (COVID-19) pandemic.

If selected for review, providers should discuss with their contractors any COVID-19-related hardships they are experiencing that could affect audit response timeliness, according to the agency. According to CMS, auditors will be “applying” any waivers and flexibilities in place during the emergency period as they conduct their claims reviews, which otherwise will follow statutory and regulatory provisions and billing and coding requirements.

The CMS announcement was released in a document titled Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions that in part addresses the resumption of certain medical review activities that have been paused by the agency since March 30.

[View source.]

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Morgan Lewis - Health Law Scan | Attorney Advertising

Written by:

Morgan Lewis - Health Law Scan

Morgan Lewis - Health Law Scan on:

Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide
- hide

This website uses cookies to improve user experience, track anonymous site usage, store authorization tokens and permit sharing on social media networks. By continuing to browse this website you accept the use of cookies. Click here to read more about how we use cookies.