July 24, 2020

CMS to Resume Claims Audits After Pandemic-related Pause

Beginning August 3, CMS will resume auditing healthcare providers’ Medicare claims after suspending most Medicare Fee-For-Service claim reviews in late March due to the COVID-19 pandemic. As a response to the pandemic, CMS released guidance announcing that it was temporarily pausing its auditing process as providers halted nonurgent procedures to redirect their focus to protect individuals from the spread of the disease. However, now CMS will move forward with its enforcement actions.

CMS released an FAQ stating that if providers impacted by the COVID-19 pandemic are selected for review, providers should discuss with their Medicare Administrative Contractor any COVID-19 related hardships that may affect the timeliness of their audit response. Since CMS permitted several exceptions to its regulatory compliance rules for healthcare providers during the COVID-19 pandemic, CMS will apply any waivers and flexibilities in place at the time of the dates of service.