News: MACs resume post-payment reviews of claims submitted post-March 2020

In response to the COVID-19 pandemic, CMS paused all Medicare Administrative Contractor (MAC) and Recovery Audit Contractor (RAC) activity in April 2020. The agency then announced they would restart reviews in August 2020, regardless of the state of the public health emergency, focusing only on claims submitted before March 2020 (essentially, pre-pandemic claims).

According to a recent MLN Connects newsletter, CMS has now authorized post-payment MAC reviews for claims submitted after March 2020. This means any claims submitted during the COVID-19 pandemic will now be under scrutiny.

The Targeted Probe and Educate program, which provides intensive education to assess compliance through three rounds of review, will restart later, according to the newsletter.

Editor’s note: To read the full MLN Connects newsletter, click here. To read denials management and appeals tips from a former MAC auditor, click here. To learn about the differences between the various auditing bodies, click here.