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.

Access a variety of SMRC related information from the StrategicHealthSolutions links below.

Completed Projects This link will take you to an external website. - View completed medical record review projects

Current Projects This link will take you to an external website. - View current medical record reviews projects

Discussion/Education Period This link will take you to an external website. - View discussion and education period timeframes and request requirements

Documentation Requests This link will take you to an external website. - View examples of documentation requests. Such as:

  • CMS ADR Cover Letter Example
  • ADR Letter Example
  • Documentation/Medical Record Submission Instructions
  • Medicare Signature Requirements Compliance
  • No Reimbursement for Medical Records

Hot Topics This link will take you to an external website. - View general topics identified when completing projects. Such as:

  • Appeal Rights
  • No Reimbursement for Medical Records
  • Physician Signature Attestations
  • Potential for Extrapolations
  • Previously Reviewed Claims
  • Submitting Imaged Records on Compact Disc (CD)

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Last Updated Aug 07, 2017