COVID-19 Update: CMS Suspends Most Audit Activities


In response to the declaration of a public health emergency (PHE) due to COVID-19, the Centers for Medicare and Medicaid Services (CMS) has suspended most Medicare fee-for-service medical review activity (audits) for the duration of the PHE.

The suspension of audits includes pre-payment reviews by the DME MACs under the Targeted Probe and Educate (TPE) program, and post payment reviews by the DME MACs, Supplemental Medical Review Contractor (SMRC), and the Recovery Audit Contractor (RAC).

In the March 26 SmartBrief, AOPA reported that  Performant Recovery, the RAC contractor, had suspended the issuance of any new Additional Documentation Requests (ADRs) associated with complex medical review audits but would continue to perform automated reviews including audits based on reasonable useful lifetime (RUL).  AOPA has since verified that the RAC will also be suspending automated reviews.

CMS has indicated that audits may still be conducted in cases where fraud and abuse is suspected.

Review CMS’s Novel Coronavirus (COVID-19) Provider Burden Relief Frequently Asked Questions here.

Questions? Contact Joe McTernan at jmcternan@AOPAnet.org, or Devon Bernard at dbernard@AOPAnet.org.

For other COVID-19 updates visit the COVID-19 Responses and Resources webpage. To see how other AOPA members are responding and to share your responses visit the Member to Member resources on the AOPA Co-OP.