Medical Review Frequently Asked Questions (FAQs)
Q1. What do I need to submit for Physical therapy audits?
A1. Noridian Medical Review has developed a listing of documentation requirements. See Outpatient Therapy Documentation Requirements webpage.
Q2. My provider is under a Targeted Probe and Educate (TPE) review. For the first round of claim reviews, the documentation request letters were not received due to an inaccurate physical address on the Medicare Provider Enrollment screen. Can this address be changed for the second round of TPE claims reviewed?
A2. Yes, the address can be changed. Reach out to Provider Enrollment to get that updated. If there are multiple Provider Transaction Access Numbers (PTANs), be sure the correct PTAN is updated with Provider Enrollment. See the Provider Enrollment webpage for more.
Q3. I am under a TPE review and was told to expect 20-40 claims to be reviewed. I only saw 10 beneficiaries during that time frame, so how will Noridian develop the other claims to reach 20-40 claims?
A3. Noridian puts edits in place to suspend billed claims until a sufficient sample is developed. This process is completely random based on your universe of claims for the procedure code(s) on review. There may be more than one documentation request letter for a beneficiary. Noridian encourages providers to maintain their regular billing patterns to entail that the review can be completed in a timely manner.
Last Updated Jul 22, 2019