DME
MAC Jurisdiction C Site LinksMedical Review
The goal of the medical review program is to reduce payment errors by identifying and addressing billing errors concerning coverage and coding made by providers.
To achieve the goal of the medical review program, contractors such as CIGNA Government Services:
- Proactively identify potential billing errors concerning coverage and coding made by providers through data analysis and evaluation of information;
- Take action to prevent and/or address the identified errors; and
- Publish local coverage determinations and policy articles to provide guidance to the supplier and medical community about when items and services will be eligible for payment under Medicare statute.
Medical review activities include Advance Determination of Medicare Coverage (ADMC) and Progressive Corrective Action (PCA).
