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Reason for ReviewĬMS tasked Noridian, as the SMRC, to perform data analysis and conduct medical review. IVIG was one of the top categories of outpatient drug claims recommended for further review. In response to the previous findings, the Centers for Medicare & Medicaid Services (CMS) implemented several Medically Unlikely Edits (MUEs) as prepayment edits to automatically detect claims billed with more units of service than what was determined reasonable for a provider to administer to a beneficiary on the same date of service for specific Healthcare Common Procedure Coding System (HCPCS) codes.Īdditionally, as a result of the above OIG report, the previous Supplemental Medical Review Contractor (SMRC), conducted research, data analysis and medical review in 2016 of outpatient drug claims.
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The OIG also found nearly 90% of overpayments were due to billing errors by the providers. As a result of these overpayments, the OIG conducted review and analysis of outpatient drug claims subsequent to the original audit period and found additional overpayments made from July 2012 through June 2014 for outpatient drugs. The Office of Inspector General (OIG) published a report in July 2015, A-09-14-02024, “Medicare Part B Overpayments for Selected Outpatient Drugs,” that identified significant overpayments exceeding $122 million made by Medicare contractors to providers for outpatient drugs during a three-year period from July 2009, through June 2012.
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Noridian Healthcare Solutions, LLC, as the Supplemental Medical Review Contractor (SMRC) for the CMS, has conducted post-payment review of claims for Medicare Medicare Part B of A Intravenous Immune Globulin (IVIG) billed on dates of service from Jthrough June 30, 2019.