MEDICAL PROVIDERS SHOULD BE AWARE THAT CMS WILL RESUME MEDICAL AUDITS BEGINNING AUGUST 3, 2020

The Centers for Medicare & Medicaid Services has announced that it will resume medical audits beginning August 3, 2020. CMS had suspended most Medicare fee-for-service audits in March due to the coronavirus pandemic. In a statement, CMS announced that the following audits would resume: pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews, and Recovery Audit Contractor (RAC) audits.

To justify the resumption in audits despite the current surge in coronavirus cases, CMS stated that “[a]s states reopen, and given the importance of medical review activities to CMS’ program integrity efforts, CMS expects to discontinue exercising enforcement discretion beginning on August 3, regardless of the status of the public health emergency.” (emphasis added) CMS did direct providers selected for review to “discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness.”

The resumption in audits is likely to create hardships for providers subject to the audits, as many providers have had to shift staff to care for COVID patients and/or have had to furlough staff due to the sharp reduction in non-emergency procedures.

CMS’ Frequently Asked Questions regarding Coronavirus Disease 2019 COVID-19 Provider Burden Relief is linked here.