CMS Suspending Medicare Fee-For-Service Medical Reviews
Due to the Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) is suspending most Medicare Fee-For-Services (FFS) medical reviews. This includes pre-payment reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate (TPE) program and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractors (RACs). Additionally, as part of the Provider Burden Relief program no further documentation for reviews will be requested from CMS for the duration of the PHE. The Targeted Probe and Educate program has also halted reviews in process, which has allowed for claims to be released and paid.
The suspension of medical claims reviews will continue until the end of the Public Health Emergency. However, CMS may conduct reviews during or after the PHE if there is suspected fraud.
More information about the “2019-Novel Coronavirus (COVID-19) Provider Burden Relief” can be found in the FAQs resource.
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