Medicare Compliance & Reimbursement

Answer: According to Centers for Medicare & Medicaid Services (CMS) guidance, Medicare fee-for-service (FFS) claims reviews are suspended due to COVID-19.

Details: At least for now, CMS has halted its pre- and post-payment review programs for the duration of the public health emergency (PHE), so that providers can focus primarily on their patients and combating the virus.

“Targeted Probe and Educate (TPE) reviews have been temporarily postponed due to the public health emergency (PHE) declared as a result of the 2019 Novel Coronavirus (COVID-19),” notes Medicare Administrative Contractor (MAC) Novitas Solutions’ online guidance.

The Part B MAC “encourages providers to focus on patient care and defer discussions related to these reviews [until] after the PHE.” Providers should also expect the MACs to “reach out to providers after the pandemic to offer education based upon prior reviews,” Novitas says.

Plus: In addition to the TPE suspension, CMS paused claims reviews by both Supplemental Medical Review Contractors (SMRCs) and Recovery Audit Contractors (RACs).

But that doesn’t mean the agency will ignore fraudulent and abusive behavior, and that’s why you should probably keep on top of your documentation and compliance during the pandemic. “CMS may conduct medical reviews during or after the PHE if there is an indication of potential fraud,” warns the agency in a Frequently Asked Questions set on provider burden relief.

Resource: Review the FAQs at www.cms.gov/files/document/provider-burden-relief-faqs.pdf.