Post-Pay Reviews - JF Part B
Medical Review
- Documentation Requests: How, Who and When to Send
- Documentation Requirements
- How to Read an ADR
- How to Respond to 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 Results |
Current Review Status |
---|---|---|---|
Annual Wellness/Subsequent Wellness Visit, HCPCS G0438/G0439 | |||
Dual-Energy X-ray Absorptiometry (DEXA), CPT® 77080 | |||
End-stage renal disease (ESRD) related monthly services, CPT® Codes 90960-90962 |
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Psychotherapy, CPT® 90834 |
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Rituximab, HCPCS Code J9312 | |||
Therapeutic Exercise, CPT® 97110 |
Last Updated Mon, 25 Oct 2021 15:28:58 +0000