CMS audits to resume August 3

July 20, 2020

Alert

At the end of March 2020, CMS suspended Medicare Fee-for-Service (FFS) review due to the COVID-19 public health emergency (PHE). CMS recently announced that it plans to discontinue that suspension on August 3 due to the reopening of states and the importance of these medical review opportunities. Accordingly, pre-payment reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program (TPE), and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC) are set to resume in just a few short weeks. This is expected regardless of the status of the PHE. CMS will apply waivers and flexibilities in effect at the time of the dates of service for any claims selected for review.

To review the FAQ issued on this topic, please click here.

For assistance with any Medicare FFS reviews, please reach out to the attorneys listed below.

Over the past 24 months, the U.S. Department of Health and Human Services Office for Civil Rights has brought notable enforcement efforts against several non-profit covered entities and business associates, resulting in instances of six and seven-figure penalties against providers across the county for incidents involving breaches of protected health information.

A new amendment to New York state law, which would have required all healthcare providers to obtain separate consents from patients for treatment and payment is on hold until further guidance is released, according to the New York Department of Health.

On November 1, 2024, the Centers for Medicare & Medicaid Services issued the Medicare Physician Fee Schedule 2025 final rule, which establishes new advanced primary care management billing codes that will expand opportunities for physician practices, federally qualified health centers, rural health clinics and other health care providers to get paid for services provided by clinical staff under the direction of a physician, nurse practitioner or physician assistant beginning January 1, 2025.

CMS audits to resume August 3

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