MACs Resume Medical Review on a Post-Payment Basis  

Situation Report | June 7, 2021

The U.S. Centers for Medicare and Medicaid Services (CMS) has announced that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical reviews for dates of service beyond March 2020.

This follows last summer’s announcement that MACs, like National Government Services (NGS), could resume post-payment reviews of items and services with dates of service before March 2020.   

The Targeted Probe and Educate (TP&E) program — which involves intensive education to assess provider compliance through up to three rounds of review — will restart at a later, as-of-yet-unannounced date. The MACs will continue to offer detailed review decisions and education as appropriate. HCA will update the membership as additional information becomes available.