Administrative Relief and Guidance on Medical Review Issues Related to Ascension Health Cyber Incident

As a result of the recent Ascension Health cyber incident, the United States Department of Health and Human Services (HHS) released a statement acknowledging the consequences the impact of this cyber incident had on the health care system across the United States. The Ascension Health Cyber Incident significantly impacts medical review processes.

The Centers for Medicare & Medicaid Services (CMS) issued the following Medicare Contractor guidance relevant to medical review issues. The guidance listed below is applicable for a 90-day period beginning on June 7, 2024.

Consistent with Chapter 3, Section 3.8 of the Medicare Program Integrity Manual (PDF), Medicare contractors shall grant administrative relief as follows:

• Providers must request and contractors shall grant extensions to medical review additional documentation requests to any provider or supplier where the provider or supplier attests to the contractor that they need more time to submit medical records as a result of the Ascension Health cyber incident
   
• If the length of time the provider or supplier requests is unspecified, to determine whether a period of 30–90 days is appropriate relief, contractors shall consider and document, on a case-by-case basis, verbal or written attestations from providers and suppliers regarding impacts. (Note: If a provider or supplier requests less than 30 days relief, contractors are authorized to grant such requests.)
   
• Contractors shall allow medical review education sessions to be rescheduled upon request of the provider or supplier
   
• Contractors may close a specific probe review and consider reopening it at a future date

Affected providers that wish to submit a request for administrative relief due to the Ascension Health cyber incident must submit a request to the Medicare contractor that issued the medical record request.

Palmetto GBA Medical Review Administration Relief Requests

Written Requests
Submit a request on company letterhead and include:

• Provider name, PTAN and NPI of billing or rendering provider;
   
• Type of administrative relief request;
   
• Reason and specific circumstances surrounding the need for the request;
   
• Copies of each Palmetto GBA medical record request that identifies the specific record requests where administrative relief is being requested; and
   
• Signature, name and date

Submit the request to Medical Review via the appropriate contract:

• Jurisdiction J Part B — Contact JJB Medical Review
• Jurisdiction M Part B — Contact JMB Medical Review
• Jurisdiction J Part A — Contact JJA Medical Review
• Jurisdiction M Part A — Contact JMA Medical Review
• Jurisdiction M HHH — Contact JMHHH Medical Review
• Railroad Medicare Part B – Contact Railroad Medicare Medical Review

Telephone Requests

• Jurisdiction J Part A and Part B: Please call 877–567–7271
• Jurisdiction M Part A, Part B, Home Health and Hospice: Please call 855–696–0705
• Railroad Medicare Part B: Please call 888-355-9165