Notifications

When Palmetto GBA identifies a service as being at risk, the potential error is validated with a review. Conducting a review ensures that medical review activities are targeted at identified problem areas. The sample of potential problem claims is used to validate the hypothesis that such claims are being billed incorrectly or in error.  You may view current service-specific reviews below.

Latest Articles

      

Medical Review Post-payment Reviews: October 2018 - September 2019 Planned Reviews 11/01/2018
Medical Review Prepayment Reviews: October 2018 - September 2019 Planned Reviews 11/01/2018
Medical Review TPE Prepayment Reviews: October 2018 - September 2019 Planned Reviews 11/01/2018
Diagnostic Radiology: Computed Tomography (CT Scan) 03/22/2018
Drugs and Biologicals: Denosumab 03/22/2018
Electrodiagnostic Procedures: Needle Electromyography (EMG) and Nerve Conduction Studies (NCS) 03/22/2018
Ophthalmology: Extracapsular Cataract Removal with Insertion of Intraocular Lens Prosthesis 03/22/2018
Therapeutic Procedures: Development of Cognitive Skills; Each 15 Minutes 03/22/2018
Therapeutic Services Billed with Modifier KX 03/22/2018
Anesthesia for Extensive Spine and Spinal Cord Procedures 11/14/2017
Anesthesia for Lower Intestinal Endoscopic Procedures: Endoscope Introduced Distal to Duodenum 11/14/2017
Bone Mass Measurements (BMM) Services 11/14/2017
Controlled Substances and Drugs of Abuse Screenings family, Presumptive and Definitive Tests 11/14/2017
Diagnostic Radiology: Chest X-Ray Services 11/14/2017
Evaluation and Management Code, Initial Hospital Inpatient Care, typically 70 minutes 11/14/2017
Evaluation and Management New Patient, Office or other Outpatient Visit: Typically 60 minutes 11/14/2017
Evaluation and Management: Emergency Department Visit, with Highly Complex Medical Decision Making 11/14/2017
Evaluation and Management: Subsequent Inpatient Hospital Care, Typically 25 minutes 11/14/2017
Medical Review of Emergency ALS Transports 11/14/2017
Medical Review of Non-Emergency BLS Transport 11/14/2017
Office/Outpatient and Inpatient/Observation Care Prolonged Services: Beyond the Usual Service Time 11/14/2017
Subsequent Nursing Facility Care, Typically 15 or 25 Minutes 11/14/2017
Medical Review Postpayment Reviews: October 2017-September 2018 Planned Reviews 11/01/2017
Medical Review Prepayment Reviews: October 2017-September 2018 Planned Reviews 11/01/2017
Review of Diagnostic Radiology: Chest X-Ray Services 02/13/2017
   

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 

Click to Chat Now