From QRM’s office of Medical Review
Author: Ashley Duggan, OTR, RAC-CT, Vice President of Medical Review and Clinical Compliance
Per communication contained in the 8/6/20 edition of CMS MLN Connects, providers received notification of resumption of medical review conducted by Medicare Administrative Contractors (MACs), as follows:
MACs Resume Medical Review on a Post-Payment Basis
To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.
To ensure receipt of ADR requests and avoid denial for non-receipt of records, it is recommended providers verify their address on file with their MAC(s). Following are detailed instructions and resources from the Novitas website and applicable across MAC(s).
Changing the Provider Address in Fiscal Intermediary Standard System
Medical Review sends Additional Development Request (ADR) letters to request medical records for review. At times, the provider address is no longer current, and the ADR letters are returned as undeliverable.
Address changes and provider file updates must be reported via the Internet-based Provider Enrollment Chain and Ownership System (PECOS). The preferred method for submitting initial applications or making address changes to your provider file is through Internet-based PECOS.
You may also print the electronic versions of the Medicare Enrollment Application CMS-855A form from the Centers for Medicare & Medicaid (CMS) website.
There are two address areas on the CMS-855A form: Master and Other. The ADR is automatically generated from the Other Address in FISS. Please ensure the Other Address reflects the address where ADRs should be mailed. Make sure all required fields are completed and the appropriate signature is submitted.
For instructions on changing your address, please visit the Tutorial: Change of Practice Address for Part A Providers (Using CMS-855A) available on our website.
Let's Get to the Point:
Ensure a process is in place for identification and management of ADR requests to ensure timely compliance and avoid denials for non-receipt of records