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ACA Now

HCERA 1302 - Medicare Prepayment Medical Review Limitations

 
Implementation Status 
 

Summary

Provides for the ability to conduct Medicare prepayment reviews to curb fraud and abuse.

Implementation Status

 
Summary 
 

Prior to January 2013, the CY 2013 Medicare Physician Fee Schedule final rule, released by CMS in November 2012, addressed the elimination of the requirement for termination of non-random prepayment complex reviews in conjunction with the authority under this provision.

On October 18, 2013, CMS issued Change Request (CR) 8427, effective November 19, 2013, delineating instructions to MACs on the 100% prepayment review of providers consistent with the authority at this section of the ACA.  A related transmittal, CR 8224, was released on September 30.

Browse ACA Titles

  • I-Quality, Affordable Health Care for all Americans
  • II-Role of Public Programs
  • III-Improving the Quality and Efficiency of Health Care
  • IV-Prevention of Chronic Disease and Improving Public Health
  • V-Health Care Workforce
  • VI-Transparency and Program Integrity
  • VII-Improving Access to Innovative Medical Therapies
  • VIII-Community Living Assistance Services and Supports (CLASS ACT)
  • IX-Revenue Provisions

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