BC Advantage - 2013 Issue 12
The Latest Development in Federal Health Care Audit Programs: Supplemental Medical Review Contractor (
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Article Overview
This article reviews a new federal medical review contractor program and places it in the context of existing Medicare and Medicaid audit activity. It is aimed at providers, suppliers, compliance teams, and health care billing professionals who need to understand how the program fits alongside other CMS audit initiatives, the general categories of services under review, and the administrative considerations associated with responding to medical review requests.
Why This Topic Matters
The article helps readers track an additional layer of CMS medical review activity that may affect documentation, audit preparedness, and compliance monitoring across multiple provider settings.
Article Sections
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Overview of CMS audit programs
Introduces the major Medicare and Medicaid audit initiatives already in place and situates the newer program within that broader environment.
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Introduction of the Supplemental Medical Review Contractor
Describes the new contractor arrangement, its timing, and the general role assigned within federal medical review operations.
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Areas currently under medical review
Summarizes the categories of services and provider types identified for current review activity and notes the broad scope of the program.
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Administrative and appeals considerations
Addresses documentation response expectations, operational burden, and the general process for challenging claim denials.
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Compliance implications for providers and suppliers
Discusses the broader compliance takeaway for organizations monitoring federal audit activity and related oversight resources.
What You Will Learn
- How the new federal medical review contractor fits into the CMS audit environment
- Which general categories of services and provider settings are being targeted for review
- What operational and documentation issues providers may need to manage
- How the article frames the broader compliance implications for Medicare and Medicaid participants
Who Should Read This
- Hospitals and health systems
- Physician practices
- Durable medical equipment suppliers
- Rehabilitation providers
- Compliance officers
- Medical billers and coders
- Health care attorneys
Codes Discussed
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