CMS suspends audits in hurricane areas

WASHINGTON, D.C., Nov. 7, 2012—Due to the effects of the superstorm that has crippled many areas in New Jersey, New York and Connecticut, the Centers for Medicare & Medicaid Services (CMS) will issue guidance to its contractors to temporarily suspend all audit activity for a period of at least 30 days. The CMS directive is effective immediately.

Since the storm struck, AAHomecare has been in constant communication with CMS and its contractors stressing the need for relief so that providers can continue to focus on patient care rather than paperwork and to ensure timely payments to meet the needs of Medicare beneficiaries. We are pleased that CMS accepted the Association’s recommendations. The guidance from CMS will state:

• Contractors shall not send MR additional documentation requests (ADRs) to any providers in New Jersey (N.J.), New York (N.Y.) and Connecticut (Conn.) for a period of 30 days from the issuance date of this technical direction letter.
• Contractors shall not deny claims from providers in N.J., N.Y., and Conn. for lack of documentation or insufficient documentation for a period of 30 days from the issuance date of this technical direction letter. Claims shall be released for payment and prioritized for post-pay review.
• Contractors shall not send ADRs or deny claims from providers in the ZIP Codes which have been designated by the Federal Emergency Management Agency (FEMA) as eligible for direct federal assistance (see list below), for an additional 30 days (a total of 60 days).

This applies only to counties with FEMA major disaster declarations eligible for direct federal assistance as of October 30, 2012 (not counties with emergency or other declarations). Information by state and county is available on the FEMA website. This applies if any part of the ZIP Code falls within the FEMA designated disaster area. Contractors may use contractor-specific coding to segregate these claims.

New York Counties
Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk

New Jersey Counties
Atlantic, Cape May, Essex, Hudson, Middlesex, Monmouth, Ocean, Union

Connecticut Counties
Fairfield, Middlesex, New Haven, New London, Mashantucket Pequot Indian Reservation

All power mobility device (PMD) claims, PMD prior authorization requests, and therapy requests for exception due to the cap are granted administrative relief only in accordance with Section 3.8 of the Program Integrity Manual. Additional clarification will be provided regarding a potential grace period when a physician, provider, or supplier is required to meet certain timeframes. CMS will reevaluate whether additional relaxation of timeframes is needed. Go online to www.aahomecare.org.