Medical Review (MR)

The Medical Review (MR) mission is to reduce provider billing errors and ensure that Medicare claims are paid correctly while maintaining the Medicare Program integrity. To reduce claim submission (coverage/coding) and payment errors, and increase timely payments, data is gathered and errors are identified and addressed. It is our philosophy to educate early and often; therefore, the MR and Provider Outreach and Education (POE) team creates coverage and guideline related articles, informational materials, and provide education on claims denied through MR and/or other review contractors. View the CMS Medical Review and Education This link will take you to an external website. webpage for details.

Documentation Requirements - View reference guides for submitting documentation to Medicare

How Do I Respond to an ADR? - Learn about the ADR process and how to submit requested documentation

MR FAQs - View frequently asked MR related inquiries and the answers to them

MR Overview - View the MR primary mission, plan and philosophy

Medical Documentation Signature Requirements - View signature requirement details

Order Authentication Requirements - View requirements as a condition of participation

Provider Self-Audit with Validation and Extrapolation (PSAVE) - This program allows providers to perform a self-audit after agreeing to waive appeal rights on universe of claims. View details

Reviews (Noridian) - View current and completed Noridian pre-payment service specific reviews

Targeted Probe and Educate (TPE) - View information on the TPE pilot process

Who Reviewed My Claim? - View information to help providers determine which contractor reviewed a claim

Why is My Claim Denied? - How to access narrative detail reasons on reviewed claims

Other Review Contractors - Multiple CMS contractors complete reviews of medical records. This includes Comprehensive Error Rate Testing (CERT) Contractor, Recovery Auditor (RA) Contractor, and many more. View details

Last Updated Feb 23, 2018

CPT and ADA End User License Agreement for Providers

NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.