CMS Allows Contractors to Deny Claims Not Under Review

CMS issued Change Request 8245 on February 5, 2014.  This will allow Medicare Administrative Contractors (MACs), Zone Program Integrity Contractors (ZPICs) and Recovery Audit Contractors (RACs) to deny even more claims.  This new rule allows the Medicare Contractors to deny claims which are related to the claims they are reviewing.

The rule states the contractors have discretion to deny other related claims submitted before or after the initial claim in question. If documentation associated with one claim can be used to validate another claim then those claims can be considered related.  The contractors are not required to request additional documentation for the related claims before issuing a denial for the related claims. 

For more information please use the following link.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R505PI.pdf