Cms manual medical review

Medicare Program Integrity Manual Chapter 3 - Verifying Potential Errors and Taking Corrective Actions. Table of Contents (Rev. , ) When medical review (MR) notification and feedback letters are issued, the MAC MR staff shall ensure that Provider.  · Noridian Healthcare Solutions, LLC, as the Supplemental Medical Review Contractor (SMRC) for the CMS, is conducting post-payment review for Medicare Durable Medical Equipment (DME) of claims billed on dates of service from January 1, through Decem. This notification includes the reasons for the review, documentation that will be requested in the Additional . The medical review threshold for is $3, This means claims that exceed the therapy threshold by more than $ in could receive a medical review. The $3, medical review threshold will last until when CMS will set a new limit. CMS retains a third-party contractor to conduct targeted medical reviews.

Medicaid programs. Having a centralized medical review (MR) resource that can perform large volume MR nationally allows for a timely and consistent execution of MR review, activities and decisions. The focus of the reviews may include but are not limited to issues identified by CMS internal data analysis, the CERT program, professional. Manual Medical Review Process Why is CMS doing this? This process is required by Section (g)(5)(C) of the Social Security Act, as added by Section of the Middle Class Tax Relief and Job Creation Act of (MCTRJA), which was signed into law on Febru. Why has CMS not issued regulations on this process?. This policy outlines two criteria, which appear to broaden the scope of claims that could be subject to review, and states that the evaluation of the number of units/hours of therapy provided in a day will be of particular interest in this medical review process. CMS has tasked Strategic Health Solutions as the Supplemental Medical Review Contractor (SMRC) with performing this medical review on a post-payment basis. The SMRC will be selecting claims for review based on.

7. maj In tasking a SMRC to conduct the therapy manual medical reviews, CMS also announced the parameters to include in post-payment reviews: Providers. Medical review of claims helps to ensure that Medicare pays for services that are Medical record documentation is required to record pertinent facts. the Medicare Trust Funds by preventing future improper payments. D. Supplemental MR Contractor (SMRC). The Supplemental Medical Review Contractor's (SMRC).