decisionhealth Newsletters, Answer Books - 2009 Issue 9 (September)
Medical Review of Claims / Postpayment Review Focuses on the Big Picture
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Article Overview
This article explains the general Medicare postpayment review process and the kinds of statistical comparisons used to flag physicians and suppliers for further review. It is intended for coders, billing staff, compliance personnel, and providers who want to understand how claims history may be evaluated after payment. The discussion covers the review cycle, the role of carrier staff, and the broad categories of claim-pattern analysis involved in postpayment monitoring.
Why This Topic Matters
Understanding postpayment review helps providers and billing teams recognize how Medicare may evaluate utilization and billing trends over time. This can support internal compliance efforts and awareness of how claims data may be reviewed for outlier patterns.
What You Will Learn
- How Medicare describes the purpose of postpayment review
- Who may perform postpayment analysis
- What types of billing and practice patterns are monitored
- How statistical comparisons are used in claims review
- Why utilization and payment trends may draw attention during review
Who Should Read This
- Physicians
- Suppliers
- Medical coders
- Billing staff
- Compliance professionals
- Practice managers
Codes Discussed
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