Wednesday, May 23, 2012

Avoid Receiving Improper Payments Before and After Processing Your Claims

Do you know how to avoid receiving improper payments before & after processing your claims?

A how-to guide on Medicare Claim Review Programs was produced by The Centers for Medicare and Medicaid and highlights the following topics:

  • Medicare Contractors and Their Responsibilities
  • Medicare Prepayment and Postpayment Claim Review Programs
  • National Correct Coding Initiatives (NCCI) Edits
    • Performed by Affiliated Contractors (ACs) /Medicare Administrative Contractors (MACs)
  • Medically Unlikely Edits (MUEs)
    • Performed by ACs/MACs
    •  FAQs on Medically Unlikely Edits
  • AC/MAC MR Program performed by ACs/MACs
  • Comprehensive Error Rate Testing (CERT) Program
    •  Performed by CERT RC and CERT DC
    •  CERT Error Rates
  • Recovery Audit Program performed by Medicare FFS Recovery Auditors
    • Summary of MR (AC/MAC Medical Review), NCCI Edits, MUEs, CERT, and Recovery Audit Program
  • Supplementary website resources with more information on Medicare Claim Review Programs
To download and view the full fact guide, please go to the following link: Medicare Claim Review Program

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