MACs and QICs limit their Audit Review
In RACmonitor, Dr. Ronald Hirsch recently wrote that “Nothing is more frustrating to a provider than having a claim denied, preparing a comprehensive appeal, submitting that appeal, and then having the appeal denied – not because the appeal wasn’t compelling or correct, but because the auditor found a second issue and the denial was upheld based on that new issue.”
“Fortunately, this frustration should be going away very soon.”
The Centers for Medicare & Medicaid Services (CMS) have limited the scope of review in certain circumstances, whereby “MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied.”
And this Means…
This means that a claim review can not be modified later with additional objections. The auditor will not be able to “pile on” additional objections if they fail to have a claim rejected based on their initial review. The auditor must submit all of its objections to a claim from the beginning, and after that, the auditor loses the right to add more objections.
For complete information on this new ruling, see RacMonitor, CMS Announces Limits on Reviews by MACs and QICs.
For more information on how to Reverse Medicare and Medicaid audits, and effectively deal with claims brought against you, contact Barraclough Health (email to firstname.lastname@example.org) to talk about your issues.