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Medical Review

The mission of Medical Review (MR) is to reduce supplier billing errors and ensure the DME MACs pay Medicare claims correctly while supporting the Medicare Program integrity.

The CGS Medical Review department consists of a Medical Director, registered nurses and other clinicians, and specially trained support staff. To achieve the goals of CMS's MR program, CGS Medical Review:

  • Finds supplier noncompliance with coverage, coding, billing, and payment policies through analysis of data and evaluation of other information.
  • Acts early and often to prevent and/or address the identified improper payment.
  • Places emphasis on reducing the paid claims error rate by notifying suppliers of review findings, educating, and making referrals to other Medicare contractors.
About Sunil V. Lalla, MD, FACS, CPC – Chief Medical Officer About Sunil V. Lalla, MD, FACS, CPC – Chief Medical Officer Physician's Corner Physician's Corner
ADMC Advance Determination of Medicare Coverage (ADMC) CPPA Prior Authorization
Artificial Limbs, Braces, Other Custom Made Items Artificial Limbs, Braces, Other Custom Made Items Medical Review Resources Provider 360
Medical Review Resources CGS Connect TPE Quarterly Reports by Policy Quarterly Status Reports
DME MAC Joint Publications DME MAC Joint Publications Medical Review Resources Resources
LCDs/Policy Articles LCDs/Policy Articles Serial Claims Review Initiative Serial Claims Review Initiative
Q&As MR Q&As Targeted Probe and Educate (TPE) Targeted Probe and Educate (TPE)
Other Medical Review Contractors Other Medical Review Contractors    

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