NEW Medical Review Organization for CMS: SMRC

The Centers for Medicare & Medicaid Services (CMS) has contracted with StrategicHealthSolutions, LLC, a Supplemental Medical Review/Specialty Contractor (SMRC) to perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs.

This is in addition to the MACs and RACs.  This is yet another medical review initiative.

One of the primary tasks will be conducting nationwide medical review as directed by CMS. The medical review will be performed on Part A, Part B, and DME providers and suppliers. Services/Provider Specialties to be reviewed will be selected by CMS, Provider Compliance Group/Division of Medical Review and Education (DMRE).  The SMRC will evaluate medical records and related documents to determine whether Medicare claims were billed in compliance with coverage, coding, payment, and billing practices.

Read more at:  

CMS Website:  http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/SMRC.html

Contractor Website:  http://www.strategichs.com/index.php/contracts/

StrategicHealthSolutions is based in Omaha, NE.  From their website:  StrategicHealthSolutions, LLC (Strategic) is a woman-owned small business designed to provide professional health care-related solutions and services for State and Federal Government. The primary focus is on the Department of Health and Human Services, specifically, the needs of State Agencies and the Centers for Medicare and Medicaid Services (CMS).

Margaret (Peg) StessmanPresident
Chief Executive Officer 

Ms. Stessman has more than 22 years of senior management experience in healthcare administration, including commercial insurance, Medicare, and Medicaid. Having worked in all three arenas has given her a thorough knowledge and understanding of both Medicare and Medicaid Fee-For-Service and Managed Care programs. She has a strong background in Quality Assurance and Utilization Management, clinical practice guideline development, data analysis and interpretation, practice pattern identification, as well as in-depth knowledge of operational and financial program management and insurance company practices, including claims processing, provider relations, and appeals and grievances. Ms. Stessman is a Registered Nurse and has maintained an active license in the State of Nebraska since 1985.

This contractor has gotten multiple CMS contracts in the past two years and is currently hiring for multiple positions.  Be alert to records requests from them.  If SNF providers receive any records requests from them, let me know and I will post a running tally here of what they are doing.  Here are their current openings.  I think it is significant that they are prepared to hire this many people at once.  Looks like they are well funded and preparing to begin some significant Medical Review initiatives based on how many folks they are taking on  now.  No word on whether SNF (A or B)  charts are one of their concerns at present.

Administrative Assistant I - Omaha, NE

Coding Specialist I - Omaha, NE (3 Positions) and Columbia, MD (1 Position)

Controller - Omaha, NE

Customer Support Representative - Omaha

Dental Auditor (Pediatric Consultant)

Healthcare Data Analyst I - Omaha, NE

Medical Review Nurse I-III - Omaha, NE or Columbia, MD

Medical Review Nurse Supervisor - Omaha, NE (1 Position) and Columbia, MD (1 Position)

Medical Review (Nurse) Training and Quality Assurance Specialist - Omaha, NE

Project and Risk Manager - Columbia, MD

Review Coordinator (Medicare Part D)

SharePoint Developer/Administrator - Omaha, NE

Graphic Artist II - Omaha, NE