Last Modified: 10/28/2022
Location: FL, PR, USVI
Business: Part A, Part B
Q. What is post-payment service-specific review?
A. A post-payment review is conducted on services/claims that have already been submitted and paid by Medicare to the provider. First Coast is required to review documentation that substantiates information reported on claims submitted for reimbursement. We do this to ensure that the Medicare program reimburses only for covered, medically necessary, items or services furnished to eligible beneficiaries by qualified providers or suppliers. The Medical Review department will be looking at services/items that are known to be frequently not billed and coded correctly per the Medicare guidelines through post-payment service specific reviews. If during the review we determine that a payment error was made, the provider will be responsible for any overpayment determined during review.
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