Tuesday, March 11, 2014

CMS Announces Another Medicare Auditing Program

Dianne De La Mare

In late 2013, the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), announced yet another Medicare auditing program – i.e., the Supplemental Medical Review Contractor (SMRC) audits. According to CMS’ information, SMRC’s will perform and provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs. The SMRC’s primary task will be to conduct nationwide medical reviews as directed by CMS. The review will be performed on Part A, Part B and DME Providers and suppliers, and will focus on medical records and documents that will help them determine whether Medicare claims were billed in compliance with coverage, coding, payment and billing practices. The focus of the reviews may include vulnerabilities identified by CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and federal oversight agencies. Strategic Health Solutions is the CMS SMRC, and has the responsibility to notify CMS of any identified improper payments and noncompliance with documentation requests. Obtain more detailed information on SMRC audits. Obtain a sample SMRC ADR letter.

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