CMS suspended most Medicare Fee-For-Service (FFS) medical review in late March due to the public health emergency (PHE). However, CMS has recently updated the COVID-19 Provider Burden Relief FAQ related to claim audit waivers. This update states that Medical Review activity is expected to resume beginning August 3, 2020, regardless of the status of the COVID-19 PHE. This announcement relates to MAC pre-payment and post-payment medical reviews under the Targeted Probe and Educate (TPE) program, as well as Supplemental Medical Review Contractor (SMRC) and Recovery Audit Contractor (RAC) reviews. Contact Proactive for assistance in responding to Medical Review activity or appealing denied claims.


Blog by Amie Martin, OTR/L, CHC, RAC-CT, Proactive Medical Review

Learn more about Amie and the rest of the Proactive team.