Monday, April 10, 2017

Medicare SMRC Announces CMS Directed SNF PPS Post-Pay Audit

Dan Ciolek


Strategic Health Solutions, LLC (SHS) is the Centers for Medicare and Medicaid Services (CMS) Supplemental Medical Review Contractor (SMRC) that is charged with conducting nationwide medical review as directed by CMS to address specific agency interests regarding coverage, coding, payment, and billing practices. Recently, the SHS website announced that on March 17, 2017, CMS directed the SMRC to conduct a post-pay audit of SNF PPS claims under project number Y4P0445. SNF providers selected for this audit may receive an Additional Documentation Request (ADR) letter directly from the SMRC contractor instead of the regional MAC.

 Here is an example ADR letter that was posted on the SMRC website. Traditionally, the SMRC audits are limited in scale so providers are not over-burdened with a large number of ADRs, but it is extremely important not to overlook or ignore the ADR requests, as late submission or non-response will result in the initiation of claim adjustments or recoupment by the MACs.  

Contact dciolek@ahca.org if there are questions.




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