Medicare resumes claim review services - memorandum of agreement required

Posted on: 4/30/21

In early 2019, CMS put claim review services on hold as they began to modify the program for coordination by a single, national contractor. 

Livanta has become that national contractor and will soon begin conducting these claim reviews in Oklahoma for CMS. These will include Short Stay Reviews, Higher-Weighted Diagnosis Related Group (HWDRG) Reviews, and other reviews, as directed by CMS. Please note that claim review services are different from the case review activities that KePro conducts in Oklahoma. In addition, this claim review is separate and distinct from audits and reviews by Novitas, the Medicare Administrative Contractor (MAC) and Cotiviti, the Recovery Audit Contractor (RAC).

All hospitals are required to have a Memorandum of Agreement (MOA) with Livanta for these reviews. For the full announcement, click here. The MOA discussion starts on Page 3 at Section 3. There you will find a link to the MOA and instructions. (LaWanna Halstead)