The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 8802 that allows the Medicare Administrative Contractors (MACs) and Zone Program Integrity Contractors (ZPICs) the discretion to deny payment on claims that are related. CMS defines a “related” claim as one where the documentation associated with one claim can be used to validate another claim.
Related claim issues are subject to CMS approval prior to the contractor’s initiating a related claim review. In addition, the MACs and ZPICs must post the related claim issue for review on their web site review within one month of initiation. The Recovery Audit Contractors (RACs) may also conduct related claim reviews but these contractors are already subject to CMS approval of claim review issues and are required to post the approved issues on their web site as part of their Statement of Work.