New “Projects” by CMS Reviewer
In September 2012, CMS selected StrategicHealthSolutions, LLC as a Supplemental Medical Review Contractor (SMRC). They support CMS by conducting reviews on specific services in an effort to lower improper payments. CMS determines the topics and time frames for the review and assigns the project to the SMRC. These reviews are nationwide and include Part A, Part B, and DME providers/suppliers.
A project to review blepharoplasty and other facial related procedures was initiated in September 2015. It included professional services and facility services. The SMRC began conducting post-payment medical reviews to determine if procedures were medically necessary. Many CCG clients received medical records requests in April 2016 associated with this particular project. This project is not yet complete.
On August 11, 2016, StrategicHealthSolutions added two additional projects specific to ophthalmology.
- Project YP0435 – Ranibizumab (Lucentis) (https://strategichs.com/smrc/project-y4p0435-ranibizumab-lucentis-2/)
- Project YP0439 – Ophthalmology Services (https://strategichs.com/smrc/project-y4p0439-ophthalmology-services/)
The links provide a detailed description of each project. A sample “documentation request” letter can be found at each of these links providing an example of what you would receive if you are included in their review process. Based on our study, these projects are related to the Office of Inspector General’s report on ophthalmic services published last fall.
For additional information regarding this SMRC, you can visit their website at: https://strategichs.com/smrc/.
As always, if you need assistance, Corcoran Consulting Group can help with coding, documentation, and reimbursement questions or to provide training or chart review and compliance questions. Visit our website or call us to learn more. You can link to our new App, Corcoran 24/7 via one of the links below.
www.corcoranccg.com (800) 399-6565