Manual Medical Review of Therapy Claims Above the $3,700 Threshold
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 be selecting claims for review based on the following:
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Does this mean Pre-Certs are no longer required?
Pre-certs have not been required for several years.
why can’t I get into the Gold Members portion, I think I am paid up membership, I
have not received any notice that I am not, but I can never get in.
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