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