Medicare Compliance & Reimbursement

If reports are accurate, the Medicare claims review reprieve may be coming to an end — sooner rather than later.

Details: In the July update of its COVID-19 Provider Burden frequently asked questions (FAQs) set, the Centers for Medicare & Medicaid Services (CMS) still lists Aug. 3 as the date when the agency will lift its claims review enforcement discretion.

“On March 30 CMS suspended most Medicare fee-for-service (FFS) medical review because of the COVID-19 pandemic,” the FAQs reminds. “This included prepayment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC).”

Now: According to the FAQs, providers should let their MACs know about COVID-19-related issues that might impact responding to reviewers and auditors. Normal standards and regulations will apply to future reviews, CMS indicates; however, the agency does mention that reviewers will take the plethora of flexibilities, waivers, and provisions into account when looking at claims.

Check out the FAQs at www.cms.gov/files/document/provider-burden-relief-faqs.pdf.