ED Coding & Reimbursement Alert - 2005 Issue 37
MEDICAL REVIEW: Have No Fear, Medical Review Will Last No More Than A Year
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Article Overview
This article explains a CMS proposal affecting the length of prepayment medical review and discusses what may happen if a provider’s claims continue to show problems during review. It is aimed at physicians, billing staff, and compliance professionals who deal with carrier documentation requests, prepayment scrutiny, and contractor audits. The article also covers broad guidance on communication, education, and outside support for practices trying to resolve review issues.
Why This Topic Matters
Understanding proposed limits on medical review duration helps practices anticipate audit timelines, manage documentation demands, and respond appropriately to carrier and contractor oversight.
What You Will Learn
- The general purpose of CMS’s proposed limit on prepayment medical review duration
- What kinds of contractor follow-up may occur if billing problems continue
- Why communication and cooperation with reviewers can matter
- How outside consulting support may help a practice navigate review issues
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Compliance professionals
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