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Medicare FFS Audits and Prior Authorization Program to Fully Return on August 3

Article provided by AAHomecare


CMS published an updated Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs) announcing that the suspension of Medicare FFS audits due to the COVID-19 Public Health Emergency (PHE) will be lifted beginning August 3, 2020. The suspension has been in place since March 30, 2020 and this announcement of lifting the suspension will allow for all Medicare audit programs to restart their normal operations including DME MAC Targeted Probe and Education, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC). CMS rationalized that state reopenings and the importance of CMS’ program integrity efforts are reasons they are lifting the audit suspension in the middle of this pandemic.

Suppliers chosen for a review should communicate any hardships due to COVID-19 that will prevent them from responding to review communication promptly. All the coverage and documentation waivers in place during the PHE will be recognized. This update can be found on the first page of the FAQ. In addition, CMS will restart full operations of the Prior Authorization program for PMDs and support surfaces beginning August 3, 2020 (page 4, FAQ). 

Resuming Audits Will Further Stress Suppliers Who Are Helping to Curb Pandemic 

"With COVID-19 cases rising dramatically across the nation, HME suppliers remain fully engaged in treating patients with COVID-19 and  helping reduce the pressure on hospitals and clinicians during this pandemic," said Tom Ryan, AAHomecare president & CEO. “This isn’t the right time to resume audit activity and ramp up paperwork demands for the HME community.”

"Many HME suppliers are more stressed by the pandemic now than they were in April and May," Ryan added. "Suppliers need all their available staff to be able to focus on helping provide effective care under the operational challenges and new safety requirements imposed by the pandemic.  In addition, many physician offices are facing their own challenges treating patients, which would be a major barrier for suppliers looking to obtain documentation needed to respond to audits."

"The facts on the ground make it clear that we're a long way away from 'business as usual' in in the healthcare sector," concluded Ryan. "CMS needs to pause or at least significantly limit audit activity until the COVID-19 Public Health Emergency is over."

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