Supplemental Medical Review Specialty Contractor (SMRC)

StrategicHealthSolutions, LLC, was selected by CMS to conduct nationwide medical reviews as directed by CMS. Services/provider specialties to be reviewed will be selected by CMS, Provider Compliance Group/Division of Medical Review and Education (DMRE). The focus of the reviews may include, but is not limited to, vulnerabilities identified by CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and Federal oversight agencies. The SMRC evaluates medical records and related documents to determine whether Medicare claims were billed in compliance with coverage, coding, payment and billing practices.

In accordance with 1833 of the Social Security Act, providers/suppliers must provide documentation upon request to support claims for Medicare services. This request complies with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which allows release of information for treatment, payment and healthcare operations.

A variety of information is accessible on the StrategicHealthSolutions, LLC This link takes you to an external website. website.

Completed Projects This link takes you to an external website. - Lists the SMRC's completed medical review projects

Current Projects This link takes you to an external website. - Lists the SMRC's current medical record reviews projects

Discussion/Education Period This link takes you to an external website. - Lists the discussion and education period timeframes and requirements

Documentation Requests This link takes you to an external website. - Lists SMRC's examples of documentation requests

Hot Topics This link takes you to an external website. - Lists general topics identified during the course of completing projects

Resource

Last Updated Apr 21, 2017