NGS Medical Review Process

Medicare contractors, like National Government Services, operate the medical review program to prevent improper payments and protect the Medicare Trust Fund. 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.

Medical review identifies errors through claim analysis and/or medical record review activities. Contractors use this information to help ensure they provide proper Medicare payments (and recover any improper payments if the claim was already paid). Contractors also offer education to help ensure future compliance. A Medicare contractor may use any necessary information to make a claim review determination, including any documentation submitted with the claim or through an additional documentation request.

If you would like information about our TPE program, please visit the TPE Home Page and review our Best Practices for a Successful Targeted Probe and Educate article.

Educational Videos

Video	Description
Comparative Billing Reports- Making the CBR Work for You	Have you received a CBR from our Medical Review Department? A CBR can be a very useful tool. Learn more how CBRS can help providers improve their billing efficiency.
MAC Medical Review Best Practices: Updating Your Contact Information	Did you know providers can now designate a separate address where they would like ADRs to be sent? To ensure you are receiving your ADR at the correct address, be sure to update your MRCA. This video will show you how to update your MRCA.