CMS to contractors: Wait until enforcement to audit

Tuesday, September 2, 2014

WASHINGTON – CMS has instructed its contractors not to retrospectively audit providers for compliance with the face-to-face requirement.

The news comes via an Aug. 20 letter sent by CMS Administrator Marilyn Tavenner to Rep. David Roe, R-Tenn., who inquired about audit activities related to the requirement after meeting with members of ATHOMES.

“The delay in enforcement on the face-to-face encounter requirements applies to reviews conducted by the DME MACs, Recovery Auditors, the Zone Integrity Contractors and Program Safeguard Contracts,” CMS states in the letter. “Once an enforcement date is announced for the delayed requirements, CMS and its contractors will begin enforcement after the announced date. When CMS begins enforcing the face-to-face encounter requirements, audits will be conducted prospectively.”

CMS implemented the face-to-face requirement July 1, 2013, but it hasn’t begun enforcing the requirement.

The delay does not apply, however, to reviews completed by the Comprehensive Error Rate Testing Program (CERT), CMS states in the letter.

“CERT must review claims in accordance with all Medicare policies to product an unbiased improper payment rate,” it stated.

Members of ATHOMES have made the face-to-face requirement a priority when meeting with their congressional members. They received support from not only Roe, but also Republican Reps. Marsha Blackburn, Diane Black, John Duncan, Chuck Fleischmann, Scott DesJarlais and Stephen Fincher.