CMS clarifies 45-day deadline for additional documentation requests

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Certain auditors that are doing prepayment reviews of Medicare claims must tell providers that they have 45 days to produce any additional documents requested (ADR), according to a recent Survey & Certification memo.

The instruction is specifically for Medicare Administrative Contractors and Zone Program Integrity Contractors, who must alert providers that failure to respond within 45 calendar days to a pre-payment ADR will result in a denial of the claim or claims.

The effective date of the instruction from the Centers for Medicare & Medicaid Services is April 1, 2015.

Click here to access the memo, which CMS distributed via email Tuesday. Click here to access the related manual update, which is dated Nov. 14.