CMS To Do Away With The 12-Month Claim ‘Lookback’ Period
Posted on 17. Jun, 2012 by dchandhok in Provider News
Typically you only have to produce records that are up to a year old when a Part B MAC contacts your practice asking to see medical records. But this time limit, however, will be done away with by the end of this month, when MACs will have more flexibility in asking for older documentation.
Currently, if a MAC asks to see your records related to claims that are under review, the MAC can collect documentation “related to the beneficiary’s condition before and after a service, but shall not request documentation dating from more than 12 months prior to the date of service unless an exception exists,” according to Section 3.2.3.4 of the Medicare Program Integrity Manual.
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However, the CMS issued Transmittal 422, which will eliminate the 12-month lookback period. This will go into effect on June 26 and no replacement period has been suggeseted. This means that records can be requested indefinitely from the date of service, although it’s not completely clear in the document whether any deadline will be introduced to replace the previous 12-month limit.
For example: You perform a hip replacement on July 1, 2012. In the past, your MAC could request the documentation from that surgery until July 1, 2013, but now you shouldn’t be surprised if you get a record request in August–or afterward.
However, you are required to anyway retain medical records for much longer than one year anyway, since state statutes of limitation dictate how long you must retain...
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