As we recover from the cold winter, Medicare has prescribed a healthy dose of alphabet soup to Medicare providers and suppliers.  New Change Request 8583 to the Medicare Program Integrity Manual (“MPIM”) imposes a new deadline on Medicare providers and suppliers to provide requested documentation during a prepayment review.

Effective April 1, 2015, the MPIM amends Chapter 3, Section to require Medicare Administrative Contractors (“MACs”), Recovery Audit Contractors (“RACs”), Comprehensive Error Rate Testing Contractors (“CERTs”) and Zone Program Integrity Contractors (“ZPICs”) to solicit additional documentation from the Medicare provider or supplier by issuing an additional documentation request (“ADR”).

A provider or supplier must provide the documentation requested in the ADR within 45 days or the claim will be denied. The MPIM instructs reviewers not to grant extensions to providers who need more time to comply with the request.

Prepay review and claims denials may quickly devastate a medical practice.  Providers and suppliers can take the following steps to protect themselves:

  • Conduct annual compliance audits
  • Update policies and procedures to prevent documentation errors identified in your compliance audit
  • Make sure billing staff are aware of the 45-day deadline to comply with ADRs