Medicare Compliance & Reimbursement

Get ready for a series of requests that will span all of your MMR-eligible claims.

Brace yourself for an ongoing barrage of additional development requests (ADRs). In resuming the Manual Medical Review (MMR) program for Part B therapy claims, the Centers for Medicare & Medicaid Services (CMS) has instructed recovery audit contractors (RACs) to conduct reviews in a series of “waves.”

RACs will conduct MMRs in five waves to address all 2014 reviews, said Springfield, MO-based Suzy Harvey, managing healthcare consultant for BKD CPAs & Advisors, in a recent analysis. If you have therapy MMR-eligible claims, you should expect to receive ADRs approximately every 45 days as follows:

• Phase 1 — The first ADR will be for one claim meeting the MMR criteria.
• Phase 2 — The second ADR can request up to 10 percent of the total MMR-eligible claims paid between March 1 and Dec. 31, 2014.
• Phase 3 — The third ADR can request up to 25 percent of the remaining MMR-eligible claims between March 1 and Dec. 31, 2014.
• Phase 4 — The fourth ADR can request up to 50 percent of the remaining MMR-eligible claims paid between March 1 and Dec. 31, 2014.
• Phase 5 — The fifth ADR can request all of the remaining MMR-eligible claims paid between March 1 and Dec. 31, 2014.