News: AHA asks CMS to continue suspension of medical review activities

The American Hospital Association (AHA) urged CMS to continue its suspension of medical review activities throughout the ongoing COVID-19 public health emergency.

At the end of March, CMS had suspended most Medicare fee-for-service medical reviews in order to allow healthcare workers to focus on fighting COVID-19. CMS has since indicated it expects to begin resuming audits the first full week of August regardless of the public health emergency’s status.

In its letter, the AHA writes it is “deeply concerned about CMS’ decision to resume these burdensome audits during a pandemic. COVID-19 cases continue to increase and the number of hospitalizations is not on par with those in April.” The AHA states that asking hospitals to put their attention back on medical reviews will “have detrimental effect on their ability to manage the pandemic for their communities at the very time when it is most needed.”

The letter also notes that CMS has recently made progress in reducing the backlog of Medicare appeals, and that “restarting these audits could exacerbate the problem and reignite unacceptable and illegal appeals delays.” The AHA says that restarting such audits would cause hospitals to make difficult decisions about providing quality patient care with less money at a time where they are already losing money because of the pandemic. “This is not the time to empower contractors to question the medical judgment of health care providers,” the agency wrote.

The AHA says that while it does appreciate the waivers and flexibilities CMS has issued, it is unclear why CMS would view audit flexibility as being different enough to withdraw it. The letter states “to be clear, we urge the agency to refrain from differentiating between medical review audits and the other flexibilities you have crated, and instead ensure all of the relevant waivers remain active during the pandemic.”

Editor’s note: The full AHA letter can be found here. ACDIS coverage of Medicare appeals backlog reduction can be found here.