Medical Review
The mission of Medical Review (MR) is to reduce supplier billing errors and ensure the DME MACs pay Medicare claims correctly while supporting the Medicare Program integrity.
The CGS Medical Review department consists of a Medical Director, registered nurses and other clinicians, and specially trained support staff. To achieve the goals of CMS's MR program, CGS Medical Review:
- Finds supplier noncompliance with coverage, coding, billing, and payment policies through analysis of data and evaluation of other information.
- Acts early and often to prevent and/or address the identified improper payment.
- Places emphasis on reducing the paid claims error rate by notifying suppliers of review findings, educating, and making referrals to other Medicare contractors.