Yet another new auditor looking at Part B claims

by  Codapedia
December 2nd, 2015

By: Scott Kraft (Aug/05/2014) 

Recovery Audit Contractors (RACs) may be about to take a break while CMS awards new contracts, but don’t rest on your laurels. CMS has handed out yet another auditor contract for a single auditor, known as a Supplemental Medical Review Contractor (SMRC) to do nationwide claims reviews for issues identified as being at risk for high dollar errors.

For Part B providers, the biggest target the new auditor, Strategic Health Solutions of Omaha, Neb., has identified is E/M claims billed with 99214 and 99215. Among the other targets are claims for hyperbaric oxygen therapy services, transformainal epidural injections (64479-64484), MRI of the lumbar spine (72148, 72149 and 72158) and some PET services (78451-78452, 78469 and 78494). 

A full list of the open items for auditing by Strategic Health Services is available at http://www.strategichs.com/current-smrc-projects/. 

The good news is, the SMRC will post its targets at the link above, which will all be referred by CMS based on issues identified by the OIG Work Plan and the Comprehensive Error Rate Testing (CERT) program, among other areas. In addition, this auditor is not being paid under a contingency fee arrangement, such as the RACs.

That may be where the good news stops. Strategic Health has posted copies of samples of the Additional Documentation Requests (ADRs) on its web site so you can see the type of letter the company will send. You get 30 days to respond, but unlike some auditors, Strategic Health Solutions will not reimburse you for the cost of copying and sending the documentation sought, as the company makes clear that this is part of the cost of doing business with Medicare. 

It’s also not as easy to send the documentation. Strategic Health Solutions will accept it via esMD, the electronic submission of medical documentation tool available at www.cms.gov/esmd. You can also fax the documentation to a fax number in the letter. It can be mailed to the contractor either on paper copies or an encrypted CD in paper format. When you use the CD option, the password must be mailed separately. 

SMRC Sample letter(pdf)

Instructions for submission(pdf) 

References:

Yet another new auditor looking at Part B claims. (2015, December 2). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/yet-another-new-auditor-looking-at-part-b-claims-27975.html

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