Manual Medical Review (MMR)
Manual Medical Review with RACs began April 1, 2013.
If problems with the MMR process arise, contact AHCA through its new Manual Medical Review Clearing House at ManualReview@AHCA.org
MEMBER ALERT – Therapy MMR ‘Pause’
April 2, 2014 – In late February, the Centers for Medicare and Medicaid Services (CMS) announced a ‘pause’ in therapy MMR reviews while it catches-up with the current backlog of MMR reviews and hires new Recovery Audit Contractors to conduct reviews. On April 1, 2014, the President signed a bill that would extend the therapy caps exceptions process and associated MMR process through March 31, 2015. While CMS has not established a date to resume MMR reviews, they have indicated that they intend to conduct post-pay review on all claims above the $3,700 threshold during the ‘pause’, and intend to conduct post-pay review on all MMR reviews in the future (including the 11 states previously subject to pre-pay review).
AHCA to Channel Members Manual Medical Review Issues to CMS
RACs are reviewing therapy claims that exceed $3,700 in 11 states through the end of 2014 (CA, FL, IL, LA, MI, MO, NY, NC, OH, PA, TX). All other states (39) will have post-payment review. Go here for more details.
Called “manual medical review,” and required by Congress, AHCA has taken steps to continuously channel providers’ problems with the process to CMS through the AHCA Manual Review Clearinghouse at firstname.lastname@example.org. If a provider is facing a problem that it cannot get resolved, we ask that the provider email the problem to the clearinghouse at email@example.com.
Read more about Manual Medical Review.