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CMS Stipulates Credentials of Medical Reviewers

Posted on Friday, September 28, 2018 6:59 PM

This week, CMS released Change Request 10909, which requires that the Medicare medical record review contractors ensure medical review audits are conducted by registered nurses, therapist or physicians.  Current LPNs may be grandfathered in and be allowed to continue to perform medical review, but no new LPNs can be hired to perform medical review.

The requirement applies to the Medicare Administrative Contractors (MACs), the Comprehensive error Rate Testing Contractors (CERT), the Recovery Audit Contractors (RACs), the Supplemental Medical, Review Contractors (SMRCs), and the Zone/Unified Program Integrity Contractors (ZPICs/UPICs).

Source: NAHC

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