On June 3, 2021 the Centers for Medicare and Medicaid Services (CMS) announced that the Medicare Administrative Contractors (MACs) may resume conducting post-payment reviews without restrictions imposed during the COVID-19 public health emergency (PHE). As you recall, early in the PHE, CMS suspended all medical review activities so that providers could focus in infection control and patient care. However, in August 2020 CMS indicated that MACs could resume post-pay review on claims with dates of service before March 2020 while offering additional flexibilities upon request due to COVID-related challenges the provider may have been facing. This CMS notice eliminates the prior restrictions and any claim for dates of service beginning March 1, 2020 could also be subject to normal MAC post-payment review processes.
CMS also indicated that the Targeted Probe and Educate program (intensive education to assess provider compliance through up to 3 rounds of review) will restart later. However, the MACs will continue to offer detailed review decisions and education as appropriate related to the current resumption of post-pay review program.