Medical Review Frequently Asked Questions (FAQs)

Q1. My claim denied for no medical necessity. How can I find out if there is a Local Coverage Determination (LCD) for a code?
A1. Check out the following link on the Noridian website for information: Active LCDs. You are also able to review the LCD information on the CMS website.

Q2. Where is there information related to the 2021 Evaluation and Management (E/M) Guidelines for office visits?
A2. Check out the following link on the Noridian website for information: Evaluation and Management (E/M). Also check out the Provider Education and Outreach site on the Noridian website for any future webinars on E/M guidelines: Schedule of Events. Check out the CMS Internet-Only Manuals website for more information: Medicare Claims Processing Manual (cms.gov), refer to section 30.6.

Q3. What is the Comprehensive Error Rate Testing (CERT) contractor and how can I tell if my claim documentation requests are from CERT?
A3. The CERT is one of the programs developed by CMS to assist in eliminating improper payments. Review the following information on the Noridian website: Comprehensive Error Rate Testing (CERT). This link has information about what CERT is and there is a specific link titled: Respond to a CERT ADR Letter, if you were to get a documentation request from the CERT contractor.

 

Last Updated Thu, 25 Mar 2021 17:51:06 +0000