- Conducted to identify, analyze and determine potential inappropriate billing and program vulnerabilities.
Postpayment Notification Letter
- Sent to provider to inform them they have been selected for postpayment claims review along with a comparative billing report showing the provider a comparison of their billing to other providers billing and informing them they are above average for their specialty.
Additional Development Request (ADR)
- Sent to provider requesting supporting documentation for claims included in the probe review, which are specified in the postpayment notification letter.
Postpayment Claims Review
Postpayment Results Letter
- Sent to provider with results of postpayment claims review.
- If dollar error rates are high and billing patterns are not in compliance with CMS directives, the provider will be put on prepayment review for the next quarter.
- If dollar error rates are low and billing patterns are within compliance with CMS directives, the provider will receive a letter with results.
- If a provider is placed on prepayment review and education is needed, you may email us at MREducationPartB@cahabagba.com.