Medicare claims reviewers were given a yellow light for using claims history information when making complex review determinations in a recent policy update. Claims history information should only be used “in limited circumstances,” and as a supplement to the medical record, the Centers for Medicare & Medicaid Services (CMS) communicated to its contractors Feb. 25. “However,” CMS said, “this policy does not prevent contractors from using claims history for other purposes such as data mining.”
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March 11th, 2011