Every MAC Starts Publishing Its Probe Results in November

If a MAC has you on a probe right now, the results letter at the end of the round counted claims. CGS spells out what goes in it: claims reviewed, claims allowed in full, claims denied in full or in part.

The decision that letter feeds runs on dollars.

CMS issued Change Request 14616 on Wednesday as Transmittal 13971, and from November 2 every A/B MAC and every DME MAC has to post its Targeted Probe and Educate results on its own website, every quarter. The section it rewrites, Program Integrity Manual §3.7.1.1, had not been revised since August 2017.

"If the MACs are finally publishing probe results, why can a provider still not tell where it stands?"

What Actually Goes on the Website

Requirement 14616.1 is one sentence, and the whole requirement lives in its qualifier: "Each quarter, MAC shall post TPE results with, at a minimum, the top and/or most common reasons for denial (list top three, if applicable) per TPE prioritized problem on their websites."

The floor is three denial reasons per open topic. Requirement 14616.1.1 says more are welcome, in the CR's own vocabulary: shall is mandatory, should is optional.

Every rate, every count and every threshold sits on the optional side of that line, which is to say nowhere in the requirement at all.

The responsibility grid marks four columns: A/B MAC Part A, A/B MAC Part B, A/B MAC HHH, and the DME MACs. The shared system maintainers get nothing, because nothing in claims processing changes.

Two other lines in the CR are worth your attention.

Provider Education: None. Impacted Contractors: None.

CMS is requiring every A/B and DME MAC in the country to publish provider-facing audit information and has budgeted zero provider education to tell providers it exists.