Post-Pay Reviews - JE Part A
Medical Review
- Documentation Requests: How, Who and When to Send
- Documentation Requirements
- How Do I Check DDE for an ADR?
- How Do I Respond to an ADR?
- MR FAQs
- MR Overview
- MR Reopening
- Medical Documentation Signature Requirements
- Medical Record Review Results
- Order Authentication Requirements
- Prior Authorization
- Post-Pay Reviews
- Pre-payment Review
- Targeted Probe and Educate (TPE)
- Who Reviewed My Claim
- Why Is My Claim Denied
- Other Review Contractors
Post-Pay Reviews
The Centers for Medicare & Medicaid Services (CMS) is required to protect the Medicare Trust Fund against inappropriate payments which pose a risk to the Trust Fund. Noridian’s focus includes performing post-payment service specific reviews identified by vulnerabilities that indicate questionable billing patterns.
Information below provides a global notice of what post-payment service topic reviews are currently in process, required documentation, resources used in reviews, and any current findings if the service topic review is completed.
| Review Criteria | Service Specific Review Notification | Current Review Status |
|---|---|---|
| Comprehensive Metabolic Panel (CMP), CPT® 80053 | ||
| Darbepoetin Alfa, Non-ESRD, HCPCS J0881 | ||
| Ferric Carboxymaltose, HCPCS J1439 | ||
| Inpatient Rehab Facility (IRF) | ||
| Intravenous Hydration, CPT® 96360/96361 | ||
| Outpatient Rehab Facility (ORF) Physical Therapy, Revenue Code 042X | ||
| Pembrolizumab, HCPCS J9271 | ||
| Polysomnography CPT® 95810-95811 | ||
|
Thyroid Stimulating Hormone (TSH) Assay, CPT® 84443 |
Last Updated Tue, 11 Jan 2022 18:12:18 +0000