Proactive Measures Related to Local Medical Review Policy


The purpose of the Medical Review process is to ensure that claims are paid correctly. The following are some measures physicians can take to help avoid any negative impact associated with the Medical Review process: 

* Review and read all carrier physician publications and LMRPs and become knowledgeable about the coverage requirements 

* Ensure that office staff and billing vendors are familiar with claim filing rules associated with any LMRP 

* Check records against claims billed 

* Create an educational awareness campaign for Medicare patients that helps them understand any specific coverage limitations or medical necessity requirements for those services provided 

* Work with claim submission vendors to incorporate LMRP edits 

* Perform mock record audits to ensure that documentation reflects the requirements outlined in the LMRP

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