Payer Updates:
Watch Out: MACs Can 'Look Back' More Than 12 Months Now
Published on Tue Jun 19, 2012
Plus, resubmit if you were a victim of the Humana claims edit that resulted in 450,000 rejections.Practices have long wondered how far back payers can go when requesting medical records for review. For Medicare, the answer has been 12 months. But that all changes soon -- on June 26 to be exact. How it works now: Currently, if a MAC requests your records related to claims that are under review, the MAC can 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 news: In Transmittal 422, which will go into effect on June 26, CMS states it will do away with that 12-month lookback period, and does not replace it with a new one. Therefore, the Manual [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
