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CMS: MACs Will Start Audits for Post-March 2020 Claims, TPE Is Still on Ice

About 10 months after resuming medical reviews of claims submitted before COVID-19 smacked the world in the face, Medicare administrative contractors (MACs) are now free to include claims with dates of services during the pandemic, CMS said in an MLN Connects posted June 3.[1] That may shift the ground for hospitals and other providers, who have been submitting claims consistent with their understanding of the waivers of some conditions of participation (CoP) and regulations and may worry their interpretation will be challenged in audits.

CMS had suspended most medical reviews on March 30, 2020, because of the pandemic. On Aug. 3, CMS turned the postpayment audit machine back on for dates of service before March 2020, although it was done in stages to ensure providers weren’t overwhelmed. In a sign that things are getting back to normal, CMS said “MACs may now begin conducting post-payment medical reviews for later dates of service.” Targeted Probe and Educate (TPE), however, remains on the sidelines; it “will restart later,” CMS said.

How it unfolds in light of the waivers is another story. A CMS spokesperson said, “All CMS review contractors are aware of the waivers and flexibilities that have been made available, and will incorporate the waivers and flexibilities into their audit strategy.”

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