Effective March 6, Medicare Administrative Contractors (MACs), Recovery Audit Contactors (RACs), and Zone Program Integrity Contractors (ZPICs) have the discretion to deny related claims submitted before or after a claim in question.
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 8425 to the Medicare Program Integrity Manual, which allows MACs, RACs, and ZPICs to automatically deny claims that are related to other claims that have been denied as a result of pre- or postpayment review. Further, they need not issue Additional Documentation Requests (ADRs) for the “related” claims prior to issuing the denial. Claims may be considered “related” if documentation associated with one claim can be used to validate another claim.
