Medicare Pre- and Postpayment Claim Review Programs Booklet

Medicare Pre- and Postpayment Claim Review Programs Booklet A copy of the Medicare prepayment and postpayment Claim Review Programs booklet, which provides detailed information on Carrier, Fiscal Intermediary, and Medicare Administrative Contractor Medical Review (MR); National Correct Coding Initiative (NCCI) Edits; Medically Unlikely Edits (MUEs); Comprehensive Error Rate Testing (CERT); and Recovery Audit Contractors (RAC), is available at www.cms.gov/MLNProducts /downloads/MCRP_Booklet.pdf . As noted in the Medicare Claim Review Programs booklet, the information provided is a general summary that explains certain aspects of the Medicare programs, which is current as of October 2010. Medicare Pre- and Postpayment Claim...

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Note:  The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article is a short reference notice for a CMS Medicare booklet covering prepayment and postpayment claim review programs. It is relevant to coders, billers, compliance staff, and other revenue cycle professionals who need a general overview of Medicare medical review and claim integrity programs, including the major review and audit frameworks discussed in the booklet. The page indicates the material is a general summary and notes the source timing of the information.

Why This Topic Matters

It helps readers quickly determine whether the underlying CMS booklet is relevant to their work on Medicare claim review, compliance, and audit-related processes.

What You Will Learn

  • What Medicare claim review programs are covered in the referenced CMS booklet
  • Which program integrity and review topics the booklet summarizes
  • The general time frame associated with the booklet information
  • Where to find the referenced CMS source material

Who Should Read This

  • Medical coders
  • Medical billers
  • Compliance staff
  • Revenue cycle professionals
  • Auditors
  • Radiology coding professionals

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