Home Health & Hospice Week

You aren’t the only one planning for when the COVID-19 public health emergency ends.

The Centers for Medicare & Medicaid Services “recognizes that it is important for stakeholders to understand how CMS anticipates performing medical review after the Public Health Emergency (PHE) has ended,” the agency says in a new message to providers.

To that end, CMS has issued a Frequently Asked Question on the matter.

Question: “At the end of the Public Health Emergency (PHE) how will CMS’ review contractors conduct medical reviews for claims billed during the PHE based on approved waivers or flexibilities?” the FAQ says.

Answer: “CMS contractors (MACs, RACs, and SMRC) review a very small percentage of Medicare Fee-for-Service claims each year. During the PHE, flexibilities were applied across claim types,” CMS answers. “All claims will be reviewed using the applicable rules in place at the time for the claim dates of service.”

When discussing durable medical equipment claims, the agency further notes that “once the PHE ends, CMS plans to primarily focus reviews on claims with dates of service outside of the PHE.” However, “we may still review … items or services rendered during the PHE, if needed to address aberrant billing behaviors or potential fraud,” CMS cautions. “The HHS Office of the Inspector General may perform reviews as well,” it adds.