CMS to Resume Medical Review Audits

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The Centers for Medicare & Medicaid Services (CMS) updated its Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs) to indicate that it will "discontinue exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency," authorizing Medicare contractors to resume conducting pre-payment and post-payment audits.

CMS suspended most Medicare fee-for-service medical reviews because of the COVID-19 pandemic on March 30. This included pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor, and Recovery Audit Contractor (RAC).

The update said that providers can discuss any pandemic-related hardships they are experiencing that could affect their audit response with their RAC if they are selected for review.

In response to CMS' announcement, the American Orthotic and Prosthetic Association said that it will be communicating its concern to CMS about the burdens that renewed audit activity will place on providers that are already operating under challenging circumstances.