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M.M.R. – K.O or OK??

Just when you thought you knew it all, CMS comes along with a brand new rule change!  New modifier or even a new code we can all live with and adjust to, but now you are telling me that we are going to change the whole MMR Manual Medical Review process?  Well that is not playing by the rules!  Unless, (Whisper it) the new changes makes things easier?!

Actually it turns out that may be the case!  CMS are proposing a new post-payment review procedure that entails more of a logical stepped approach for the RACS (Recovery Audit Contractors).

The new procedures will allow the RACS to issue up to 5 individual ADRS (Additional Documentation Request’s) starting with a document request for the first claim that took the patient over their annual MMR Manual Medical Review limit.  As always there has to be a 45 day gap between each ADR, however with each subsequent ADR the RAC can request more documents. The RAC will have the ability to request up to 10% on the second request, 25% on third, up to 50% on the fourth and 100% of documentation by the fifth request.

This seems like a more logical and organized method, allowing for easier resolution of MMR Manual Medical Review and a shorter review period.  However before we get too excited, this new procedure does not yet apply to claims made in 2015, as yet only applies to outpatient therapy facilities and has still be completely finalized.

We had a feeling that this might have been too good to be true, but we are confident that this method will prove more successful and become standard procedure.