Medical reviews begin for pandemic claims

Effective Jun 3, 2021

Published Jun 3, 2021

Last Reviewed Jun 3, 2021

Medicare Administrative Contractors (MACs) have resumed post-payment medical reviews on claims during the public health emergency, according to Palmetto GBA and the latest MLN Connects newsletter.

Since August, MACs have limited medical reviews to claims with dates of service before March 2020.

"MACs may now begin conducting post-payment medical reviews for later dates of service," CMS said in a statement.

The Targeted Probe and Educate program (intensive education to assess provider compliance through up to 3 rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate, CMS said.

Look for more coverage on these new medical reviews in upcoming issues of Home Health Line.

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