Four months after supplemental medical review contractor (SMRC) StrategicHealthSolutions LLC began examining five claims from every agency nationwide in an effort to create more consistent audits among CMS contractors, it has begun issuing claims denials.
 
Agencies are receiving letters from the SMRC indiciating claims have been denied. The letters state that a Medicare administrative contractor (MAC) may initiate overpayment recoupment actions and appeals can’t be requested unless the MAC sends an overpayment demand letter.
 
CMS initially announced plans to review the claims in the wake of an April 10 report from the Office of Inspector General (OIG) indicating CMS oversight of the face-to-face requirement for home health is “minimal” and that billions in payments shouldn’t have been made.
 
For more information about the SMRC’s review, see the upcoming issue of Home Health Line.