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Provider Alert: CMS Announces Plans to Resume Provider Audits August 3, 2020

On March 30, 2020, the Centers for Medicare & Medicaid Services (“CMS”) suspended most Medicare Fee-For-Service medical reviews because of 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”). 

For providers whose practices were adversely impacted by the public health emergency, and may have reduced their administrative support staff, the audits may present a logistical hardship.  In its public notice, CMS recommended that providers discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness.   This may include, but is not limited to, the unavailability of a licensee to verify medical documentation because the licensee is a frontline caregiver treating COVID-19 patients.

CMS notes that waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will be applied.  In light of the tremendous disruption caused by the pandemic and the pace at which guidance was developed and published, there is a risk that audited claims will be reviewed without due consideration of the applicable waivers or exemptions, or other relevant circumstances.   Audited providers are well-advised to thoroughly review all claims, as well as the results of CMS’ review to ensure that all applicable waivers and exemptions were taken into consideration.  Even in the absence of a published waiver or exemption, providers may choose to submit a description of exigent circumstances to attempt to avoid a potential recoupment or offset.

How Frier Levitt Can Help

For more information about responding to a CMS audit, contact Frier Levitt to speak with an attorney.