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Anesthesia Coding Alert

Reader Question:

Don't Be Surprised at MAC 'Look Back' Beyond a Year

Published on Wed Aug 08, 2012

Question: How far back can payers go when requesting medical records for review? Oklahoma Subscriber Answer: For Medicare, the answer to your question has been 12 months -- until recently. Effective June 26, 2012, a new policy regarding "look backs" went into effect. Under the old guidelines, a Medicare Administrative Contractor (MAC) could collect documentation "related to the beneficiary's condition before and after a service but shall not request documentation dating from more than 12 months prior to the date of service unless an exception exists," according to Section 3.2.3.4 of the Medicare Program Integrity Manual. The change: In Transmittal 422 (which went into effect June 26), CMS stated it would do away with that 12-month look-back period. The Transmittal did not specify that CMS was replacing the 12-month look-back period with a new time frame (or if any deadline would be introduced later to replace the previous limit). Therefore, the Manual [...]
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