TAILIEUCHUNG - Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and Recovery Audit Program

There are no right or wrong answers regarding a company’s choice of functional focus for its internal audit department. Where stakeholders choose to position the function on the Internal Audit Continuum is a direct reflection of their risk appetite and corresponding assurance needs as expressed in the mission statement. The mission statement must be tailored to the organisation and the value drivers identified in Step 1 of the framework. Too often, organisations fail to address this key linkage, simply adopting preconceived mission statements from other entities or internal audit departments | DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare Medicaid Services Official CMS Information for Medicare Fee-For-Service Providers Medicare Claim Review Programs MR NCCI Edits MUEs CERT and Recovery Audit Program ICN 006973 July 2012 Medicare Claim Review Programs MR NCCI Edits MUEs CERT and Recovery Audit Program DISCLAIMER This booklet was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This booklet was prepared as a service to the public and is not intended to grant rights or impose obligations. This booklet may contain references or links to statutes regulations or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes regulations and other interpretive materials for a full and accurate statement of their contents. ICD-9-CM Notice The International Classification of Diseases 9th Revision Clinical Modification ICD-9-CM is published by the United States Government. A CD-ROM which may be purchased through the Government Printing Office is the only official Federal government version of the ICD-9-CM. ICD-9-CM is an official Health Insurance Portability and Accountability Act standard. CPT Disclaimer -- American Medical Association AMA Notice CPT only copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS DFARS Restrictions Apply to Government Use. Fee schedules relative value units conversion factors and or related components are not assigned by the AMA are not part of CPT and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not .

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