MMR Cycles Continue
Providers continue to feel the pain of the 5 cycle MMR review process under RACs for 2014 claims. The 2015 “Doc Fix” with legislated changes to the medical review process has yet to be implemented by CMS.
The National Association for the Support of Long Term Care has met with CMS but have yet to receive a concrete summary of what CMS plans to do with the new medical review process which should be implemented soon.
As a refresher, CMS can pull claims for review based on a provider’s denial rate, if they are a new provider, based on a certain diagnostic group and so on.
Providers, most importantly, are concerned with the interpretation of the “by denial rate” considering the only denial rate data reflects the disastrous implementation of MMR in 2012 and the seemingly unending ALJ pause.
NASL and AHCA continue to work with CMS and legislators to influence these interpretations to protect therapy services for beneficiaries and providers from unnecessary administrative burden and medical review.
Cynthia Norton, Executive Vice President of NASL, informed its membership concerning their visit with CMS 6/19/15. She said, “I was at CMS today to meet with staff regarding the new targeted medical review for therapy claims above $3,700. The statute calls for implementation of the new process in mid -July. CMS indicated they will not have a process ready by then. They do think one will be ready before the end of the year.”
Stay tuned to Reliant Reveal Monthly!