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5 Years of Biosimilars in the US: What Have We Learned? 


CMS suspended Medicare audits on March 30, 2020 because of the declared public health emergency, due to the Covid-19 pandemic.  At the beginning of August, CMS reinstated all Medicare audits. 

Correct coding is critical for community-based practices to maximize reimbursement and mitigate the risk of a Medicare audit. Specialty practices often have complicated coding, so many practices will typically experience some type of audit.

CMS has created an FAQ to understand some issues that have evolved due to the pandemic.  For example: not enforcing the signature requirements on proof of delivery slips for certain Part B drugs and Durable Medical Equipment (DME). They understand many practices were not having direct contact with vendors, but rather used a drop-off system.

Practices should note that if you are scheduled for an audit and are experiencing any hardships related to Covid-19, it is up to the providers to discuss those with the MACs (Medicare Administrative Contractors), SMRCs (Supplemental Medical Review Contractor) or RACs (Recovery Audit Contractor). The contractors may offer different options for responses.

If your practice would like help in identifying your risks for a potential CMS audit, as well as analyzing your billing and coding processes, contact