Courtesy of the National Association for Home Care & Hospice

The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical review for later dates of services.

On March 30, 2020, CMS suspended most Medicare fee-for-service (FFS) medical review because of the COVID-19 pandemic. On August 17, 2020, CMS resumed medical review but limited the time frame to claims with dates of service prior to March 1, 2020 (the beginning of the COVID-19 Public Health Emergency (PHE)).

The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The Medicare Administrative Contractors (MACs) will continue to offer detailed review decisions and education as appropriate.

For any medical reviews for dates of service during the current PHE, providers will want to carefully examine the review decision to ensure that any PHE waivers and flexibilities were considered. The most current waivers and flexibilities can be found here.

As a reminder, the current post-payment review topic for Palmetto GBA is "Home Health Services for Eligibility and Medical Necessity", which includes the review of inpatient claims submitted for home health services for eligibility and medical necessity.