CMS Extends Audit Moratorium to MMRs

The Obama administration has extended its moratorium on health care audits to include the controversial manual audits, offering another olive branch to long term and post-acute care advocates.

Last week, providers breathed a sigh of relief when the Centers for Medicare & Medicaid Services (CMS) announced that it would “pause” reviews under its Recovery Auditor Contractor program. The reviews were principal culprits behind a monstrous backlog of audit appeals that has swamped the agency.

The CMS pause announcement left open questions about whether the so-called Manual Medical Reviews (MMRs) would continue.

In a clarifying letter to advocates, CMS says that the manual reviews are on hold as well. The suspension is applied retroactively to last week’s recovery audit announcement, CMS says.

Additionally, CMS says that it’s tweaking its audits to address many provider concerns.  Under just-announced or pending rules, auditors now must:

  • Wait at least 30 days “to allow for a discussion” if a provider says that he or she will appeal an audit decision.  Previously, auditors had to end talks when notified of an appeal. 
  • Wait to be paid any contingency fees until after the second level of administrative appeals has concluded. Previously, auditors were allowed to take the cash even if a case was on appeal; and
  • Adjust their document requests to a provider’s denial rates.

Overall, advocates say they’re pleased with CMS’ new posture but still say the central problem isn’t so much the audit process as the audit policy itself. Providers say they have no objection to catching crooks, but the current policy treats everyone as if they were already guilty and ties innocent providers up for weeks, and even months, on endless reviews and paperwork requests—only to be followed by months of appeals.

Bill Myers is Provider’s senior editor. He can be reached at wmyers@providermagazine.com.  Follow him on Twitter, @ProviderMyers.