CMS to Resume Medical Review Activity August 3, 2020

CMS to Resume Medical Review Activity August 3, 2020

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.

Holly Hester

Holly Hester is Casamba’s Senior Vice President of Compliance & Education, as well as the Compliance Officer. She provides regulatory guidance and interpretation, clinical programming and content development, education and training steerage, and compliance support for the company. As a physical therapist for more than 20 years, Holly has multi-venue clinical and management experience, giving her a unique perspective on the integration of compliance and training with therapy service delivery and clinical practice.
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