Thursday, April 3, 2014

CMS Booklet Describes Medicare Review Programs

Dan Ciolek

Earlier this year, CMS released a booklet designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors; in particular, coverage and coding errors.

The “Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and Recovery Audit Program” booklet includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Program Contractor, and the Comprehensive Error Rate Testing Program.

AHCA members should note that this booklet does not include a description of the Part B therapy manual medical review (MMR) conducted by Recovery Auditors for claims surpassing the $3,700 annual per-beneficiary threshold. Therapy MMR falls under different provisions than the Recovery Audit Program described in this booklet. See the AHCA Therapy MMR webpage for updated information.

Please contact Dan Ciolek if you have questions or comments.

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