27.07.20 | Noreen Hiltsley

CMS to Resume Fee for Service (FFS) Medical Reviews

To our valued customers:
CMS expects to resume Fee for Service (FFS) Medical Reviews on August 3, 2020, regardless of the status of the Public Health Emergency (PHE), which has just been extended to October 23, 2020.

BACKGROUND
On March 30, 2020, CMS suspended most FFS medical reviews because of the COVID-19 pandemic. This included pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate Program (TPE), and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews, and Recovery Audit Contractors (RACs).

CURRENT RECOMMENDATIONS & FACTS
For those providers that may have been adversely impacted by the Public Health Emergency, CMS recommends they discuss any COVID- 19 related hardships with their contractor, that could affect audit response timeliness.

Although waivers and flexibilities in place at the time of the dates of service of any potential claims will be applied, there is a risk that claims will be reviewed without due consideration of the applicable waivers, exemptions, etc.

As your valued partner, Preferred Therapy Solutions will work with you to thoroughly review audited claims, and CMS review results to ensure that all such waivers and exemptions are taken into consideration.

Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for a thorough understanding on practices and procedures. If you have any questions, please contact  Maria Maggi, Vice President of Quality, Outcomes, and Compliance at mmaggi@preftherapy.com