Medical Review
The Centers for Medicare & Medicaid Services (CMS) states the following regarding Medical Review (MR):
The goal of the medical review program is to reduce payment error by identifying and addressing billing errors concerning coverage and coding made by providers. To achieve the goal of the MR program, contractors:
- Proactively identify potential billing errors concerning coverage & coding made by providers through analysis of data (e.g., profiling of providers, services, or beneficiary utilization) and evaluation of other information (e.g., complaints, enrollment and/or cost report data);
- Take action to prevent and/or address the identified error. Errors identified will represent a continuum of intent, and;
- Publish local medical review policy to provide guidance to the public and medical community about when items and services will be eligible for payment under the Medicare statute.
Medical Review Articles
Attestation Statement - Example 
Comparative Billing Reports - A Provider's Tool for Improvement (11/23/09)
CPT 99231-99233 Comparative Billing Reports for Service Specific Probes
CPT Code 99213 (All Specialties) -- Planned Widespread Service-Specific Probe Reviews for Established Patient Office or Other Outpatient Visits for Wisconsin, Illinois, Michigan and Minnesota
Guidelines for the Use of Scribes in Medical Record Documentation (12/30/09)
Hospice and Billing of Evaluation and Management Services (08/30/10)
Inpatient Split/Shared Evaluation and Management (E/M) Services (11/16/09)
Medical Review Mission
Medical Review Progressive Corrective Action (PCA)
Medical Review Strategy
Planned Widespread Service-Specific Probe Reviews for Subsequent Hospital Visits for Wisconsin, Illinois, Michigan, and Minnesota (11/02/09)
Planned Widespread Service-Specific Probe Reviews for Established Patient Office or Other Outpatient Visits for Wisconsin, Illinois, Michigan and Minnesota
Service Specific Probe Results for Subsequent Hospital Care CPT Code 99233 - Internal Medicine (Specialty 11)
Signature Guidelines for Medical Review Purposes
Important Links
Page Last Updated: Friday, 27-Aug-2010 16:43:06 CDT
