I have been receiving an increase in emails asking about the certification and recertifcation process for Medicare beneficiaries receiving outpatient therapy services. This is due to Strategic Health Solutions, the supplemental medical review contractor who is auditing claims that exceeded $3700 in a calendar year, denying many claims and citing the reason as the physician did not certify (sign and date) the plan of care in a timely manner. Under Medicare Part B therapy services, the initial certification is considered timely if the physician or non-physician practitioner (NPP) signs and dates the plan of care within

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law on April 16, 2015, extended the therapy cap exception process through December 31, 2017 and modified the requirement for manual medical review for services over the $3,700 therapy thresholds. MACRA eliminated the requirement for manual medical review of all claims exceeding the thresholds and instead allows a targeted review process. MACRA also prohibits the use of Recovery Auditors to conduct the reviews. CMS has tasked Strategic Health Solutions as the Supplemental Medical Review Contractor (SMRC) with performing this medical review on a post-payment basis. The SMRC will

StrategicHealthSolutions (SHS), LLC was awarded as the Supplemental Medical Review Contractor (SMRC), a Specialty Medical Review Contractor, supporting the Centers for Medicare and Medicaid Services (CMS). The SMRC will perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the outpatient therapy cap exception process until December 31, 2017 and modified the requirement for manual medical review for services over the $3700 therapy thresholds. One of the tasks SMRC