Corporate

January 27, 2016

Medical Review Areas of Focus For 2016

Strategy Item
Status of 2016 Probe Initiation
1. Evaluation and Management
Probes in progress

a. Office Visits – New/Established

Probes in progress

b. Hospital Visits – Initial/Subsequent

Probes in progress

c. Hospital Visits - Critical Care

Planned for February 2016

d. Emergency Room Visits

Probes in progress

e. Home Visits

Probes in progress

f. Nursing Home Visits

Probes in progress

g. Modifier 25

Probes in progress
2. Lab Tests
Data Analysis Pending
3. Ambulance
Probes in progress
4. Drugs
Data Analysis Pending
5. Chiropractic
Probes in progress
6. New Providers
Probes in progress
7. Surveillance (Other as identified by data analysis, complaints, referrals, etc.)
Probes in progress
8. Edits/Audits
NA

 


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