MACs Expanding Post-Payment Medical Reviews

June 4, 2021

 

The Centers for Medicare & Medicaid Services (CMS) released a notice on June 3, 2021 advising that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical reviews of items and services for dates of service March 2020 and after.  Previously, MACs had resumed post-payment reviews only for dates of service before March 2020.   CMS also advised that the “Targeted Probe and Educate” program, involving intensive education to assess provider compliance through up to three rounds of review, will restart later.  Finally, CMS advised that the MACs will continue to offer detailed review decisions and education as appropriate.

As the country continues to “re-open,” clients should expect to see increased audit activity from not only CMS, but also from other federal and state agencies, as well as from commercial payers/health plans.  Garfunkel Wild routinely advises clients on all aspects of payer audits and regularly works with reviewers from Garfunkel Health Advisors (GHA), a heatlhcare consulting subsidiary.  GHA’s reviewers add significant clinical, practical and real-world expertise on the complex documentation, coding and billing issues that routinely arise during a payer audit.

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Should you have any questions regarding the above or if you are currently being audited and need assistance, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.

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