July 2020

CMS TO RESUME PRE- AND POST-PAYMENT AUDITS

The Centers for Medicare and Medicaid Services (CMS) has authorized Medicare contractors (eg, DME MACs, RACS, SMRCs, etc.) to once again perform pre-payment and post-payment audits as part of their medical review responsibilities. CMS had suspended most audits as of March 30, 2020, due to the COVID-19 Public Health Emergency. CMS has indicated that due to the “importance of medical review activities to CMS’ program integrity efforts, it discontinued exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency.” CMS indicated that if individual providers who are selected for medical review believe that responding to a request for documentation will create a hardship situation, they should discuss response options with the contractor performing the review.

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