The selection of topics and time frames to be reviewed is determined by and at the direction of CMS. The Supplemental Medical Review Contractor (SMRC) is assigned each project through Technical Direction Letters (TDL) issued by CMS.
The focus of the projects may include, but are not limited to issues identified by Federal agencies, such as the Office of Inspector General (OIG), Government Accountability Office (GAO), CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and First-Look Analysis Tool for Hospital Outlier Monitoring (FATHOM) report and Program for Evaluating Payment Patterns Electronic Report (PEPPER). The SMRC is conducting medical review based on the analysis of national claims data versus data that is limited to a specific jurisdiction as performed by Medicare Administrative Contractors (MACs).
The SMRC will be performing medical review projects in accordance with CMS regulations, CMS Publication 100-08 (known as the Program Integrity Manual) and other current and future CMS PCG/DMRE initiatives.
Strategic is currently performing medical record review on the following projects: