Medical Review Administrative Relief Related to the Novel Coronavirus (COVID-19) Pandemic

The Centers for Medicare & Medicaid Services (CMS) has authorized nationwide waivers under §1812(f) of the Social Security Act retroactive to March 1, 2020, for those impacted by COVID-19. Medicare Fee-For-Service (FFS) operations will implement the following policies and procedures for all claims, not just for the COVID-19 diagnoses.

Additional Documentation Requests (ADRs)

  1. For ADRs that have already been issued, Medicare contractors will release the claims for payment and not issue claim denials; providers should not respond to any pending claims as all claims will be released for relief efforts.
  2. Any claims auto-denied for non-response of an ADR from March 1, 2020, until March 26, 2020, will have the denial reversed and allow payment if an appeal has not been filed. If an appeal has been filed, normal appeals processes will be followed.
  3. As of March 26, 2020, future ADRs will not be sent until further notice from CMS

Targeted Probe and Education (TPE)

  1. All current TPE reviews and associated edits are suspended and selected claims released for payment
  2. MACs will allow TPE medical review education sessions to be rescheduled upon provider request

Note: Providers must resume compliance with normal Medicare fee-for-service rules and regulations as soon as they are able. The waivers or modifications a provider was operating under are no longer available after the termination of the emergency period.

Last Updated: 04/06/2020