tci General Surgery Coding Alert - 2020 Issue Q3

Reader Questions: CMS Restarting Medical Review

Question: I’ve heard that CMS is suspending medical reviews for the duration of the COVID-19 public health emergency. Is that correct? SuperCoder Subscriber Answer: Although CMS initially suspended Medicare fee-for-service (FFS) medical claims reviews on March 30 due to COVID-19 Public Health Emergency (PHE), the suspension has ended. The PHE was extended: https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-23June2020.aspx Details: The initial suspension included pre-payment medical reviews that Medicare Administrative Contractors (MACs) performed under the Targeted Probe and Educate program, as well as MAC’s post-payment reviews, Supplemental Medical Review Contractor (SMRC) reviews, and Recovery Audit Contractor (RAC) reviews. Now CMS...

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