CMS Extends Medical Review Dates

From NAHC

The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical review for later dates of services.

On March 30, 2020 the Centers for Medicare & Medicaid Services (CMS) suspended most Medicare Fee-For-Service (FFS) medical review because of the COVID-19 pandemic.  On August 17, 2020 CMS resumed medical review but limited the time frame to claims with dates of service prior to March 1, 2020 (the beginning of the COVID-19 Public Health Emergency (PHE)).

The Targeted Probe and Educate program (intensive education to assess provider compliance through up to 3 rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.

For any medical reviews for dates of service during the current PHE, providers will want to carefully examine the review decision to ensure that any PHE waivers and flexibilities were considered.  The most current waivers and flexibilities can be found here.

As a reminder the current post-payment review topics for each of the home health and hospice MACs are listed below.  CMS just announced the expansion of the dates eligible for review so these topics may be updated to reflect this and/or a change in topics.