Railroad Medicare: Pre-payment Reviews
Practicefirst would like to make you aware of Pre-payment Reviews currently underway for Railroad Medicare.
These reviews are currently being conducted through September 2019 for the following E&M codes: 99204, 99205, 99222, 99223, 99231, 99232, 99233, 99284, 99285, 99291, 99308 and 99309. They are also reviewing the following Radiology codes: 71045, 71046 and 77080, as well as Therapy services. The reason for their record review is to confirm that services rendered are in accordance to the Medicare guidelines for medical reasonableness and necessity.
Railroad Medicare is also conducting Pre-payment Targeted Probe and Educate (TPE) Reviews spanning from October 2018 through September 2019. These reviews are also to confirm that services rendered are in accordance to the Medicare guidelines for medical reasonableness and necessity. Providers will receive a letter requesting the contact information of the individual who will be the point-of-contact for these reviews. Railroad Medicare will share their findings with this individual. The CPT codes involved in the Pre-payment review are: 99211 through 99215, 99231 through 99233, 99284, 99285 and 99304 through 99309. A few podiatry services are also included in the Pre-payment reviews.
The Targeted Probe and Educate reviews are designed to help providers reduce claim denials. Medicare Administrator Contractors use data analysis to identify common claim errors with a high error rate. Providers whose claims are compliant with Medicare policy will not be chosen for a TPE.
To learn more about the TPE’s, National Government Services has provided a 6-minute You Tube video which can be accessed at the following website: