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08/12/2020

MACs Resume Medical Review on a Post-Payment Basis

 

To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with post-payment reviews of items/services provided before March 1, 2020.

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

Here are two product categories currently be audited as announced by CGS:

1. Widespread Post-Pay Service Specific Review Announcement – HCPCS Code A4253

https://cgsmedicare.com/jc/pubs/news/2020/08/cope18387b.html

2. Widespread Post-Pay Service Specific Review Announcement – HCPCS Code L0650

https://cgsmedicare.com/jc/pubs/news/2020/08/cope18387a.html

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