Prepayment review pilot project recently launched by CMS.
The Centers for Medicare and Medicaid Services (CMS) has launched a three-year Medicare prepayment review demonstration project in 11 states. The prepayment reviews focus on high cost procedures with a high error rate. The Recovery Auditors (RAs) will perform the reviews. If the project is successful, CMS is likely to require prepayment reviews for all Medicare claims. Case managers should determine the payer mix and volume for targeted procedures and ensure that the documentation meets medical necessity criteria.
D014487:Centers for Medicare and Medicaid Services, U.S.; D017048:Health Care Costs; D007345:Insurance Claim Review / Q000458:organization & administration*; D010865:Pilot Projects; D012051:Reimbursement Mechanisms / Q000592:standards*; D014481:United States