- Through analysis of CMS identified vulnerabilities, data analysis, medical review of claims and other reports, potential service specific and/or provider specific inappropriate billing is identified.
Prepayment Probe Notification Article:
- Posted in Cahaba’s ‘What’s New’ section informing providers of an upcoming Part A prepayment probe.
Additional Development Request (ADR):
- Sent to provider requesting supporting documentation for claims included for services billed. The ADR letters will be mailed and /or the claim in question will be in status location S B6001 that identifies claims in FISS that are in an ADR status/location.
Prepayment Probe Results Article:
- Posted in Cahaba’s “What’s New” Section informing providers of probe results.
- If dollar error rates are high and billing patterns are not in compliance with CMS directives, the probe will be continued as a widespread targeted prepayment review.
- If dollar error rates are low and billing patterns are within compliance with CMS directives, a results article will be posted with educational material included on Cahaba’s “What’s New” section and the prepayment probe will be closed.
- If specific providers are identified with high error rates and the issues identified are not widespread, provider specific prepayment review will be initiated.
- If the provider has educational needs related to the probe, you can contact MREducationPartA@cahabagba.com.