CMS has announced that it will resume Medicare Fee-For-Service (FFS) medical reviews August 3, 2020 regardless of the status of the COVID-19 public health emergency. These audits have been suspended since March 30 as a result of the crisis and applied to prepayment reviews and post-payment reviews conducted by Medicare Administrative Contractors (MAC).
However, due to state re-openings and the importance of the program integrity activity, CMS will start reviews from DME Medicare Administrative Contractors, RAC Audits (Recovery Auditor Contractors) and Supplemental Medical Review Contractors (SMRC). Targeted Probe and Education (TPE) audits are not included in this roll out and there is no timeline for when they will resume.
Practices should prepare for potential audit activity and discuss with their contractors any COVID-19 related hardships they are experiencing that could affect audit response timeliness. According to CMS, auditors will be applying any waivers and flexibilities in place during the COVID emergency period as they conduct their claims reviews, which otherwise will follow statutory and regulatory provisions and billing and coding guidelines.