Tag: QICs
CMS limits scope of audits
September 1, 2015HME News Staff
WASHINGTON - For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed the MACs and QICs to limit their scope to the reason the claim or line item was initially denied, according to a recent MLN Matters article.
In the past, the MACs and QICs have had the discretion to develop new issues and review all aspects of coverage and payment related to a claim or line item.
“In some cases, where the original denial reason is cured,...