CMS announced last week that it expects to resume audits on August 3, as related to CMS’ program integrity efforts. This decision was made in light of states reopening regardless of the ongoing public health emergency status.
CMS suspended most Medicare Fee-For-Service (FFS) medical review activities on March 30, due to the COVID-19 pandemic. This included pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews, and Recovery Audit Contractor (RAC).
Providers selected for review should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness. CMS notes that all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will also be applied.