tci Medicare Compliance & Reimbursement - 2012 Issue 13

Audits: CMS Update: Your Old Records Now Fair Game for MAC Claims Review

CMS nixes the one-year lookback period effective June 26.Part B MACs now have more flexibility than ever in requesting older documentation from your practice during claims audits, according to a new CMS transmittal, which removes the 12-month lookback timeframe. Background: Currently, if a MAC requests your records related to claims that are under review, the MAC can collect documentation "related to the beneficiary's condition before and after a service, but shall not request documentation dating from more than 12 months prior to the date of service unless an exception exists," according to Section 3.2.3.4...

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