Medical Review
The Medical Review Program is designed to promote a structured approach in the interpretation and implementation of Medicare policy. 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
- Investigational Devices
- Rural Air Ambulance Protocols
- Self-Administered Drugs
- Calendar of Educational Events
- Online Courses
- CERT
Page last updated: September 22, 2008
