Cardiology Coding Alert

Question: Since the COVID-19 public health emergency (PHE) is still ongoing, does our practice really need to worry about medical record reviews by the Centers for Medicare & Medicaid Services (CMS)?

California Subscriber

Answer: Although CMS put many investigations and reviews on pause during the pandemic, the agency is again looking into medical record reviews.

The agency may be looking at medical records of Medicare Parts A and B beneficiaries through additional development requests (ADRs) and Targeted Probe and Educate (TPE) programs for rationale to support skilled services, says Kris Mastrangelo, OTR/L, LNHA, MBA, president and CEO of Harmony Healthcare International.

You know CMS works with Medicare Administrative Contractors (MACs) for claims processing and other administrative functions. Your respective MAC would probably be a key connection point in assisting CMS with local claims, as well as reviewing the first level of appeals adjudication functions, Mastrangelo says.

Resource: Check out this CMS guidance at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/ Downloads/TPE-QAs.pdf.