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 (PCG)/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.

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Last Updated Apr 23, 2018