Medical Record Review Results - JA DME
Medical Record Review Results
Targeted Probe and Education (TPE) Reviews - Due to COVID-19, all TPE activities have been suspended.
Service Specific Pre-Payment Reviews - Noridian has no current active Service Specific Pre-Payment Reviews
Service Specific Post-Payment Reviews - Postpayment review occurs when a reviewer makes a claim determination after the claim has been paid. Postpayment review results in either no change to the initial determination or a “revised determination” indicating that an overpayment or underpayment has occurred.
MACs Resume Medical Review on a Postpayment Basis
To protect the Medicare Trust Fund against inappropriate payments, Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities. Beginning August 17, the MACs are resuming with postpayment reviews of items/services provided before March 1, 2020. The Targeted Probe and Educate program (intensive education to assess provider compliance through up to three rounds of review) will restart later. The MACs will continue to offer detailed review decisions and education as appropriate.
|Review Criteria||Current Error Rate||Review Notification|
CMS Internet Only Manual (IOM), Publication 100-08, Chapter 3
Last Updated Wed, 16 Sep 2020 14:26:25 +0000