MACs Resume Medical Review on a Post-Payment Basis

Reimbursement; CMS

​A few weeks ago, AHCA alerted members that CMS was planning on resuming some medical review audit activities starting August 3. CMS also indicated that providers could request flexibilities from the audit contractors if they were currently challenged with the COVID-19 situation in their community. On August 6, CMS made the below clarification related to MAC-specific audits. If you experience MAC audit activities that are different than described below, please submit an email describing the situation to (please no privacy-protected information).   

CMS Announcement:​

“To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with post-payment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and ducation as appropriate.”