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CMS limits scope of audits

September 1, 2015HME News Staff

WASHINGTON - For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed the MACs and QICs to limit their scope to the reason the claim or line item was initially denied, according to a recent MLN Matters article. In the past, the MACs and QICs have had the discretion to develop new issues and review all aspects of coverage and payment related to a claim or line item. “In some cases, where the original denial reason is cured,...

Audit, Medicare, Medicare Administrative Contractor (MAC), QICs