CMS Provides Further Clarification On The Manual Medical Review Process for 2013

March 27, 2013
Rick Gawenda
On March 21, 2013, the Centers for Medicare and Medicaid Services (CMS) released additional guidance on manual medical review for outpatient therapy services exceeding $3,700 in calendar year 2013. This applies to all Part B outpatient therapy settings except critical access hospitals.
Medicare Administrative Contractors (MACs) will conduct prepayment review on claims reaching the $3,700 threshold with dates of service January 1, 2013 to March 31, 2013.  CMS requested MACs conduct these manual medical reviews within 10 days. At this time, there is no advance request for an exception process. Effective April 1, 2013, the Recovery Auditors will conduct review for all claims processed on or after April 1, 2013. Recovery Auditors will complete two types of review. The two types of reviews with applicable time frames for completion are listed below.

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