Welcome to the Service Specific Review Index. The following table lists and summarizes the active post-payment service specific medical record review activity for Medical Review Part B.
On August 17, 2020, medical review activity resumed, as directed by the Centers for Medicare and Medicaid Services (CMS), with implementation of post-payment service specific medical record review. For additional information please see Medicare Learning Network (MLN) Connects newsletter.
Novitas Solutions, Inc. is tasked with preventing inappropriate Medicare payments. One of the ways this is conducted is through Medical Review of claims. Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded and medically reasonable and necessary.
Novitas Solutions performs data analysis on a regular basis on all services billed to Medicare to identified services which are frequently not billed and coded correctly per the Medicare guidelines. If you bill Medicare these services, you may receive an additional development request (ADR) to allow Novitas to validate your billings of these services. Once received, you will have 45 days to respond to the request with the supporting medical record documentation. The review will be completed within 60 days of receipt of the medical record documentation. When the review is completed, you will be notified of the results.
Medical Review Part B has the following service specific reviews in effect: