Fee for Service Medical Review Expected to Resume August 3, 2020

From QRM’s office of Medical Review:

Per an updated FAQ, CMS has provided notification of anticipated resumption of the medical review process, suspended since March:

Q. Is CMS suspending most Medicare Fee-For-Service (FFS) medical review during the Public Health Emergency (PHE) for the COVID-19 pandemic?

A. On March 30 CMS suspended most Medicare Fee-For-Service (FFS) medical review because of the COVID-19 pandemic. This included pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC). 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. If selected for review, providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness. CMS notes that all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will also be applied.

The full document may be accessed at https://www.cms.gov/files/document/provider-burden-relief-faqs.pdf

Let's Get to the Point:

Ensure a process is in place for access/assembly/submission of clinical records to manage review requests timely and comprehensively to secure and maintain reimbursement as billed