Post-Pay Reviews - JE Part A
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