CMS Clarifies Issue Regarding MMRs

The Obama administration has made clear that its moratorium on health audits also include the controversial manual audits, offering even further relief to long term and post-acute care advocate. I first saw this reported by Provider. Now, it is all over McKnights as well.

A few weeks ago, providers breathed a sigh of relief when the Centers for Medicare & Medicaid Services (CMS) announced that it would “pause” reviews under its Recovery Auditor Contractor program. The reviews were principal culprits behind a monstrous backlog of audit appeals that has swamped the agency.

The CMS pause announcement still left open questions about whether the so-called Manual Medical Reviews (MMRs) would continue.

But CMS has clarified things, and says that the manual reviews are on hold as well.

Additionally, CMS says that it’s tweaking its audits to address many provider concerns. The agency says its thinking about changing contracts so that auditors must:

  • •Wait at least 30 days “to allow for a discussion” if a provider says that he or she will appeal an audit decision. Previously, auditors had to end talks when notified of an appeal;
    •Wait to be paid any contingency fees until after the second level of administrative appeals has concluded. Previously, auditors were allowed to take the cash even if a case was on appeal; and
    •Adjust their document requests to a provider’s denial rates.

Overall, advocates say they’re pleased with CMS’ new posture but still say the central problem isn’t so much the audit process as the audit policy itself.

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