In a revised FAQ document posted July 7, 2020, CMS announced it will resume medical review activity beginning August 3, 2020, regardless of the status of the public health emergency. This includes the resumption of pre-payment medical reviews conducted by the Medicare Administrative Contractors (MACs) as part of the Targeted Probe and Educate (TPE) program and post-payment review by the MACs, Recovery Audit Contractor (RAC), and the Supplemental Medical Review Contractor (SMRC). CMS states, if selected for review, providers should discuss with the contractor any COVID-19-related hardships they are experiencing that may affect the timeliness of their response to any requested audit.
In addition, CMS announced the Home Health (HH) Review Choice Demonstration will resume on August 3 in all five demonstration states: Illinois, Ohio, Texas, North Carolina, and Florida. The initial choice selection period for North Carolina and Florida will begin August 3 and end August 17, 2020. The choice selection period for Ohio’s second review cycle will also begin August 3 and end August 17, 2020. Following these selection periods, HH claims in all demonstration states with billing periods beginning on or after August 31, 2020, will be subject to review under the terms selected by the provider. CMS reiterated that the HH demonstration is scheduled to end on May 31, 2024, with no extension planned at this time.
For more information, access CMS’s Provider Relief FAQ document.
And, access the information about the HH Review Choice Demonstration.
