Post-Pay Reviews - JF Part A
Medical Review
- 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
- Pre-Claim Review
- 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 |
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Hyperbaric Oxygen (HBO) Therapy, HCPCS G0277 |
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Inpatient Rehab Facility (IRF) |
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Intravenous Hydration, CPT® 96360/96361 |
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Outpatient Rehab Facility (ORF) Physical Therapy, Revenue Code 042X |
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Polysomnography CPT® 95810-95811 |
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Last Updated Wed, 17 Feb 2021 18:27:00 +0000