Drug Test(s), G0477-G0483 – Widespread Service Specific Targeted Review Notification

CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. To meet this requirement, the Noridian Part B Medical Review (MR) analyzes national and local data in conjunction with the findings from the OIG and other CMS contractors such as Comprehensive Error Rate Testing (CERT) and Recovery Auditor (RA) to identify atypical billing. After data analysis, MR must verify if billing problems exist through claim reviews to validate provider compliance with Medicare coverage as well as coding and billing guidelines. If issues are identified, MR then determines the severity of problems and develops interventions to correct the problem. This notifies providers of the initiation of a Service Specific Targeted Review for Laboratory claims on HCPCS codes G0477-G0483.

SOURCE: Source
INDUSTRY NEWS TAGS: Noridian Healthcare Solutions, MAC JE California, MAC JE Nevada, MAC JE Hawaii

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