If the COVID-19 pandemic is interfering with their ability to fulfill audit demands, hospitals and other providers should ask for leniency from Medicare auditors, top CMS program integrity officials say. Auditors are expected to push back deadlines if necessary, and they must reduce the number of additional documentation requests (ADRs) temporarily. Meanwhile, Targeted Probe and Educate (TPE), the prepayment reviews by Medicare administrative contractors (MACs), is still on ice, except in connection with potential fraud referrals. But TPE will definitely return.

That’s life in the slow lane, as medical reviewers and auditors step back into oversight in the middle of a pandemic after CMS exercised “enforcement discretion.”

“As part of reopening, we are encouraging providers to discuss with contractors any COVID hardships they are experiencing that could affect audit response timeliness,” said Dan Schwartz, director of CMS’s Division of Medical Review, at the virtual CMS Provider Compliance Focus Group Oct. 19. He said MACs, recovery audit contractors (RACs) and the supplemental medical review contractor (SMRC) “will grant extensions to documentation requests as needed due to COVID-19-related impacts.”