The
Centers for Medicare & Medicaid Services (CMS) has contracted with
Strategic Health Solutions, LLC, a Supplemental Medical Review/Specialty
Contractor (SMRC) to perform and/or provide support for a variety of tasks
aimed at lowering the improper payment rates and increasing efficiencies of the
medical review functions of the Medicare and Medicaid programs.
One
of the primary tasks will be conducting nationwide medical review as directed
by CMS. The medical review will be performed on Part A, Part B, and DME
providers and suppliers. Services/Provider Specialties to be reviewed will be
selected by CMS, Provider Compliance Group/Division of Medical Review and
Education (DMRE). The SMRC will evaluate medical records and related
documents to determine whether Medicare claims were billed in compliance with
coverage, coding, payment, and billing practices.
The
focus of the reviews may include, but is not limited to vulnerabilities
identified by CMS internal data analysis, the Comprehensive Error Rate Testing
(CERT) program, professional organizations and Federal oversight agencies.
Robert
Liles has published a good article regarding Strategic Health Solutions. He will be speaking in February at our
Stepping Up For Home Health and Stepping Up For Hospice on the topic of
“Preparing and Responding to an Audit by RACs or ZPICs”. I am sure he will also cover this new audit
contractor. We have listed a link below
to Robert’s article.
CMS Link
http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/SMRC.html
Robert Liles Article Link
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