National Government Services (NGS) published information on its October 14, 2011 list-serve that they have launched a new “Mobile Medical Review” program.
The NGS announcement stated:
The Mobile Medical Review team will provide on-site medical review of processed claims to verify that Part A Medicare payments were issued appropriately. The team will provide immediate feedback to the provider during the review regarding any deficiencies noted in the medical documentation, and the rationale for any determination that the claim should not have been paid as billed.
Selected providers will receive a letter notifying them of an upcoming on-site review. Included in this letter will be a list of the claims that will be reviewed during the visit. Providers will be asked to:
- Prepare the medical documentation necessary to support the billed services
- Participate in the on-site review by attending an entrance and exit conference and being available for questions throughout the review
Once the review is complete, a written summary will be issued to the provider with the review findings. The summary will include a list of all claims reviewed along with the team’s determinations. It will identify denials and include an explanation of why the provider is responsible for any overpayments, an estimate of over or underpayment, and a description of any follow-up actions to be instituted by either the provider or National Government Services.
If the on-site review reveals any significant issues with the claims reviewed, the provider will receive a letter notifying them of a follow-up on-site review. The follow-up visit will be scheduled approximately four to six weeks following the initial visit. During this visit, the team will review records for claims billed after the initial site visit, to ensure that the facility is utilizing the feedback and references previously provided.