Medical Review Postpayment Reviews: Drug Testing

Palmetto GBA Railroad Medicare may perform a postpayment review of claims, meaning that medical documentation is requested for claims that have already been processed and paid. Post payment review can be done in cases where a high error rate and/or potential overutilization has been identified through data analysis. Upon review of the documentation, Railroad Medicare Medical Review clinicians will make a determination that either affirms the original payment, or denies the payment (in part or in full). If any part of the claim is denied, an overpayment is assessed, and funds are recouped from the provider. The next Planned Review will review certain Drug Testing codes.