![]() ![]() Contractors also provide education to help ensure future compliance.Ī Medicare contractor may use any relevant information they deem necessary to make a prepayment or post-payment claim review determination. Contractors use this information to help ensure they provide proper Medicare payments (and recover any improper payments if the claim was already paid). Medical reviews identify errors through claims analysis and/or medical record review activities. What is the purpose of the medical review program? Medical reviews involve the collection and clinical review of medical records and related information to ensure that payment is made only for services that meet all Medicare coverage, coding, billing, and medical necessity requirements. ![]() To prevent improper payments and protect the Medicare Trust Fund, Medicare contractors operate the medical review program. ![]()
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