May 14, 2014
Supplemental Medical Review Contractor (SMRC) Project Home Health Phase Two
The Centers for Medicare & Medicaid Services (CMS) assigned the SMRC to do medical review of Medicare home health agencies (HHAs) for the purpose of performing reviews to validate that the most recent and valid face-to-face (FTF) encounter is in the record. Medical review was conducted in five separate phases over the period of one year for the affirmation or non-affirmation of the required FTF encounter documentation.
Upon completion of Phase Two of the review (Project number Y1P18), SMRCs provided a results letter to the HHAs with claims included in the review. The results will be available on the SMRC website.
CMS has provided instructions to CGS for the recovery of overpayments on approximately 828 claims as a result of the Phase Two project. Adjustments will soon be made by CGS and can be identified by the following indicators:
- Type of bill = 32I
- Status/location = D B9997
- Reason code = 5SMRX (where X = 1-9)
- Remark = SMRC Phase 2
Please note that the limitation on recoupment (935) applies to these adjustments. This means that if a valid first or second level appeal is received on SRMC phase 2 adjustments, CGS cannot recoup the overpayment until the decision on the redetermination and/or reconsideration is made. For more information about the 935 process, refer to the Medicare Learning Network® article, "Limitation on recoupment (935) for Provider, Physicians and Suppliers Overpayments" on the CMS website.
For additional information, please review the details of the SMRC project (Y1P18/Y2P18) on the SMRC website.