Last Modified: 11/11/2020
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 Affairs 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.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.