The Supplemental Medical Review Contractor (SMRC), Noridian, has been assigned a new project that was updated earlier this month, in April 2026. This initiative is specifically targeting home health services and will involve selecting claims with dates of service spanning from January 1, 2024 through December 31, 2024.
This project may seem surprising given that we are now in 2026. However, Medical Review is permitted to go back as far as three years when identifying claims for audit. Because of this, they will be reviewing the claims that fall between dates of service January 1 and December 31, 2024.
Additionally, when outlining the purpose of this project, they note that it is based on data analysis from the 2024 calendar year. This analysis examined shifts in care patterns and utilization following the implementation of the PDGM model, which took effect on January 1, 2020. From this review, they identified particular concerns related to patients who have remained on service for more than 361 days.
These cases clearly fall into the category of extended length-of-stay patients. At this time, it’s unclear whether the review will be limited strictly to long-term cases; however, agencies with a higher number of patients who had prolonged stays during that calendar year will likely see increased focus.
When reviewing the project details, it specifies that any documentation request will clearly identify the time period under review. However, if the patient has an extended length of stay, or if the requested 30-day period does not include the Start of Care, you will still need to submit the Face-to-Face Encounter documentation along with the original Start of Care/Plan of Care that established the initial certification at admission.
In addition, you should include the initial therapy evaluation and any subsequent re-evaluations if therapy services are part of the period under review. Along with that, all relevant visit notes, OASIS assessments, and any other documentation tied to the requested timeframes must be submitted.
Based on past SMRC audit patterns, while not guaranteed in this instance, it’s common for them to select a small group of patients but review multiple episodes or benefit periods for each one. For example, they may request records for ten patients, but each of those patients could have several benefit periods under review. Because of this, it would not be unusual to see multiple periods requested for the same patient, particularly for those with extended lengths of stay.
We strongly encourage you to review all documentation carefully and thoroughly. If you receive a letter regarding this SMRC audit, it will outline the reason for the review and provide clear instructions on what documentation must be submitted.
It is best practice to organize your records in a clear and structured manner. Ensure pages are numbered, documents are in order, and include a table of contents. You should also provide a cover letter that not only summarizes the care delivered but also clearly explains the patient’s eligibility for the services provided.
Healthcare Provider Solutions stands ready to assist with any level of Medical Review and are happy to help in any way we are needed. Please reach out to us.
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