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From the Reimbursement Team: Good News -Post-Pay Audits

In a recent MLN article, SE1521 released August 19, 2015, there is good news for the DMEPOS industry.

On Post-Payment Review/Audits at redeterminations and reconsiderations, the reviews are limited to the reason the claim or line item at issue was initially denied. This applies to ZPIC, RAC, MAC, CERT, post payment audits. This is for requests received by MAC or QIC on or after August 1, 2015.

Prepayment reviews can continue to develop new issues and evidence at their discretion and may issue unfavorable decisions for reasons other than those specified in the initial determination.

To read the full MLN article, click here.

Reimbursement Team

Ronda Buhrmester
Dan Fedor