Medical Review Frequently Asked Questions (FAQs)

Q1. Where can I find the Evaluation and Management (E&M) information on the Noridian website?
A1. There is information on the Noridian website for multiple specialties. These can be reached by clicking on the Browse by Specialty tab on the main page. Check out the following link on the JFB Noridian website for this information. Specific information can be found at Evaluation and Management (E/M).

Q2. How do I know what the signature requirements are for medical documentation?
A2. For a note to be valid, it must be authenticated by the author. The signature shall be handwritten or an electronical signature and must be legible. More information can be found at Medical Documentation Signature Requirements.

Q3. My claim was denied for not meeting incident to criteria. Where can I locate the incident to requirements?
A3.  It is important to understand incident to criteria to ensure claims are being billed appropriately. Please refer to incident to criteria on our Noridian Medicare website. There is also incident to criteria information located in the CMS Internet Only Manuals (IOM). Please refer to the Medicare Benefit Policy Manual, chapter 15, section 60 and the Medicare Claims Processing Manual, chapter 12.

Q4. I am currently on a post-payment review and would like to know the interim findings prior to the completion. How can I get a status update on my review?
A4. If you would like to receive information regarding findings specific to your facility prior to the completion of the review, send an email to medicalreviewb@noridian.com. In order to facilitate the response, follow these instructions:

  • Complete the Subject line with the following information: Results request for [enter in your CPT®/HCPCS code on review] widespread review
  • In the body of the email, include the following elements:
    • Your name, title, and telephone number
    • The facility name
    • NPI Number
    • Short description of information you would like to receive
  • Indicate if you would like to receive results via phone call, fax or US Mail and include a fax number or mailing address as applicable.

Upon request receipt, Noridian Medical Review will respond as timely as possible. Requests may take up to two weeks to be completed.

 

Last Updated Wed, 16 Jun 2021 18:31:47 +0000