CMS Releases Additional Guidance on Post-PHE Medical Reviews

BIRMINGHAM, Alabama (November 11, 2022)—The Centers for Medicare & Medicaid Services (CMS) has published a clarification regarding medical review audits after the public health emergency (PHE) ends. This is the first public guidance CMS has published regarding audits after the end of the PHE, according to the American Association for Homecare (AAHomecare). 

In the clarification, CMS says that at the end of the PHE, it plans to focus mainly on reviewing durable medical equipment (DME) claims with dates of service outside of the public health emergency, for which clinical indications of coverage are applicable. 

“We note that we may still review these DME items, as well as other items or services rendered during the PHE, if needed to address aberrant billing behaviors or potential fraud,” the document states. “The HHS-Office of the Inspector General may perform reviews as well. All claims will be reviewed using the applicable rules in place at the time for the claim dates of service.”

That’s good news for DME providers, AAHomecare said. 

“AAHomecare is pleased to learn that CMS will not be primarily focused on waived claims,” the organization wrote in an email to members.

Suppliers can find additional information by CMS regarding Medicare compliance program here. 

AAHomecare has been in contact with CMS concerning the transition out of the PHE and will continue to work with CMS and Medicare contractors as end of the PHE nears. The PHE is currently in effect until at least January 11, 2023.