This minute covers the news release from CMS concerning: MACs Resume Medical Review on a Post-payment Basis.

Hello, everyone, and welcome to our Monday Minute. Today I want to talk to you about the release from CMS, just last week, about Medical Review. As you all know, and we have discussed on our Monday Minutes, they reinstated Post Payment Reviews as of August 2020, and that is for all reviewers. However, they had limited the audits to dates of service prior to March 1, 2020, which precedes the Public Health Emergency. The announcement just last week, is that they are now going to allow Post Payment Reviews fully. This means during the Public Health Emergency, the dates of service where you have provided care during the Public Health Emergency, will now be subject to Post Payment Review. We knew this day would come, there’s no doubt. I do want to add that Targeted Probe and Educate has not been reactivated. But interestingly enough, they did say in the announcement last week, that Targeted Probe and Educate would start again at a later period of time. With this initiation of Post Payment Reviews during the Public Health Emergency, it is concerning and there are going to be issues, we fear, with some of the COVID waivers that CMS issued regarding Medical Review.

One of my biggest concerns is face-to-face encounters via telehealth. In the states that are in the Review Choice Demonstration, currently specifically participating in Pre-Claim Review, there have been multiple issues regarding this, because of the fact that the physician has not been documenting that the telehealth face-to-face encounter was done via audio and video. It has to be that the physician is able to see and hear the patient and the patient is able to see and hear the physician. Not only is it good enough that you know that that took place, it has to be documented in the physician’s face-to-face encounter documentation. I just want to make sure that you are fully aware of that, and if you began receiving Post Payment Reviews where that face-to-face encounter was done via telehealth, and he did not document both audio and video, you need to get that attestation. Preferably you’re getting that attestation before you bill the claim, because there is no assurance that an attestation will work once you bill the claim. These are all of course going to be Post Payment Reviews. I am a bit concerned about some of the other waivers. That one is definitely the number one. I’m also concerned that there are going to be some telehealth visits that have been discovered as being actually reflected on the claim which makes it a billable service. We all know that telehealth cannot be billed on traditional Medicare claims.

These were a couple of the items that I wanted to make sure that you knew were concerns as we move forward in this world of Post Payment Reviews on dates of service that were during the Public Health Emergency. That is not to say that every request you get for records is going to be during the Public Health Emergency. But they have opened up those dates, and I wanted to make sure that you were prepared.

CMS Announcement

As always, thank you for taking care of patients during, the still active, Public Health Emergency. Please be tuned in to your State and National Home Care Associations, as conferences are being scheduled in LIVE events, which we are very excited about and I hope to be able to see you at one of those very soon. Take care and have a great week. Keep fighting the fight against COVID-19!

If your agency has a request for post payment review, please don’t hesitate to reach out to HPS if you need assistance Contact Us  HPS is always here to support you.

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