CMS Provider Relations Coordinator for Medical Reviews

Nancy Leveille and Carl Pucci in Finance & Reimbursement

The Centers for Medicare and Medicaid Services (CMS) recently announced the establishment of a Provider Relations Coordinator to help increase program transparency and offer more efficient resolutions to providers affected by the medical review process (here).

The Provider Relations Coordinator’s purpose is to improve communication between providers and CMS.  While providers should continue to take questions about specific claims directly to the Recovery Auditor or Medicare Administrative Contractor (MAC) who conducted the review, providers can raise larger process issues to the Coordinator.  For example, if a provider believes that a Recovery Auditor is failing to comply with the documentation request limits or has a pattern of not issuing review results letters in a timely manner, CMS encourages providers to contact the Provider Relations Coordinator. Prior to the establishment of this new CMS initiative, AHCA members often contacted AHCA staff to help facilitate an escalation of their medical review issues with CMS. Hopefully this new process will help streamline the resolution of such issues.

CMS indicted that providers can also send suggestions about how to improve the Recovery Auditor or MAC medical review process to the CMS Provider Relations Coordinator.

The CMS Provider Relations Coordinator is Latesha Walker, and she can be contacted at:

If you have any questions or are not satisfied with CMS follow-up when using this new process, please contact Dianne De La Mare or Dan Ciolek at AHCA.

NYSHFA CONTACTS:

Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36