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Medical Review
The Medical Review Program is designed to promote a structured approach in the interpretation and implementation of Medicare policies. CMS makes it a priority to automate this process; however it may require the evaluation of medical records to determine the medical necessity of Medicare claims. The goal of the contractor’s MR Program is to participate in reducing the contractor’s claims payment error rate (CERT) by identifying, through analysis of data and evaluation of other information, program vulnerabilities concerning coverage and coding made by individual providers and by taking the necessary action to prevent and address the identified vulnerabilities.
Additional Section Links
- Additional Development Request Process
- Rural Air Ambulance Protocols
- Calendar of Educational Events
- CERT
Page last updated: July 31, 2009
