Medicare administrative contractor (MAC) Palmetto GBA is reminding providers under the Review Choice Demonstration that their claims can still be reviewed by other audit groups, regardless of whether the claims were cleared under pre-claim review.
CMS contractors, including Unified Program Integrity Contractors (UPIC) and the MACs, may conduct targeted prepayment and post-payment reviews to ensure that claims are accompanied by documentation not required or available during the pre-claim review process, Palmetto noted in an alert to providers Feb. 10, 2026.
In addition, the CMS Comprehensive Error Rate Testing (CERT) program reviews a stratified, random sample of claims annually to identify and measure improper payments.
“It is possible for a home health claim that is subject to pre-claim or post-payment review to fall within the sample,” Palmetto notes. “In this situation, the subject claim would not be protected from the CERT audit.”