Medical Review Policy (MRP)

Impact on Reimbursement  Make no mistake, the Medical Review Policy (MRP) matters and it plays a key role in determining the care that is reimbursable by a payer. The MRP is an administrative and educational tool designed to help providers, physicians, and suppliers submit correct claims for payment. Medical Review Policies outline how contractors review...
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Medicaid Reference Documents

Download Reference Documents Most of the resources a clinic will need can be found on the dedicated Medicaid website for their state. Listed below are some resources developed by CMS that can assist with understanding key aspects of the Medicaid program. How to Use the Medicaid National Correct Coding Initiative (NCCI) Tools Medicaid Provider Enrollment...
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Commercial Health Insurance Reference Documents

Download Reference Documents This course provided an overview of types of commercial health insurance plans and the importance of locating the payer’s medical review policies. The reference documents listed below are samples of medical policies from a variety of common payers. Use these documents as a guide to track down similar forms on payer websites....
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Records Preparation Reference Documents

Download Reference Documents Third-party payers provide information on their website to assist providers with meeting the payer’s recordkeeping expectations. It is prudent to know the medical review policy and other administrative policy that relate to the payers with whom the practice does business. Included here are two samples from two different payers that outline guidelines...
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