Medical Review:
Review Lookback Period Booted
Published on Thu Jun 14, 2012
Your MAC could request files older than 1 year.When your HHH Medicare Administrative Contractor asks you for medical records, you can typically count on the fact that the records won't be more than a year old. That time limit however, will be eliminated later this month, and MACs will have more flexibility in requesting older documentation.Background: Currently, if a MAC requests your records related to claims that are under complex medical review, the MAC can collect documentation "related to the beneficiary's condition before and after a service, but shall not request documentation dating from more than 12 months prior to the date of service unless an exception exists," according to Section 3.2.3.4 of the Medicare Program Integrity Manual.New way: Now the Centers for Medicare & Medicaid Services has issued Transmittal No. 422, which will go into effect on June 26. The directive will do away with that 12-month lookback period, [...]
