CMS reinstates audits, prior auths

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Friday, July 10, 2020

WASHINGTON – Starting Aug. 3, auditors will restart their audit functions, according to a recently published FAQ from CMS.

If selected for review, HME providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness, states the guidance.

CMS says all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will also be applied.

Although claims billed during the public health emergency will be subject to audits, CMS will not be enforcing the signature requirement on proof of delivery for dates of service within the PHE, which is expected to be extended past its current July 25 end date.

CMS is also reinstating prior authorizations for DMEPOS.

For power mobility devices and pressure reducing support surfaces that require prior authorization as a condition of payment, claims with an initial date of service on or after Aug. 3, 2020, must be associated with an affirmative prior authorization decision to be eligible for payment.