Medical Review Contractors
The Centers for Medicare & Medicaid Services (CMS) utilizes a number of contractors to conduct medical review of claims and documentation, including:
- Medicare Administrative Contractors (MACs), including CGS
- Comprehensive Error Rate Testing (CERT) contractors
- Recovery Auditors (RAs)
- Zone Program Integrity Contractors (ZPICs)
- Supplemental Medical Review Contractor (SMRC)
Information about the CERT program and contractors is available on the CGS Part A CERT web page. Other information related to CGS medical review and medical review by other contractors is available on this web page. You may also find the following resources helpful:
- General information about medical review programs: CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 1

- Recovery Audit Program

- Supplemental Medical Review Contractor

- The role of Zone Program Integrity Contractors: CMS MLN Matters article SE1204


