Medicare pre & post payment chart review resolution.
Medicare pre & post prepayment review occurs when the Medicare claim processing system suspends a claim for medical review before the claim is paid. Prepayment edits are designed to prevent payment for non covered and/or not medically necessary services. Prepayment edits are established, modified and evaluated for effectiveness on an ongoing basis. Some of the current services being selected by Medicare for prepayment review include level 4 office visit CPT codes, Ultrasounds, EKG and other diagnostic tests, Botox injections and anesthesiologist pain management injections.
Sade Medicare Consulting contracts with former Medicare nurse chart auditors who evaluate your medical charts in-order to ensure that the chart documentation supports the CPT codes billed to Medicare and that Medical necessity for diagnostic tests and other ancillary services is documented in the physician charts.