F CUECs – Medical Review (MR)

30.9.3 – F CUECs – Medical Review (MR) (Rev. 331, Issued: 11-15-19, Effective: 10-01-19, Implementation: 12-17- 19) F – Control Objective Number F – CUEC Description F.1 CMS provides proper access to the CERT Claim Status website for retrieval and reporting of CERT feedback data. F.2 CMS reviews and approves the workloads and costs submitted by the contractor. F.1, F.2 CMS reviews and approves the Strategy Analysis Report (SAR) through its CMS ART System and analyses projected workload, cost, variances to projections and assigns a unique control number/system location code for suspended claims. F.1, F.3 CMS provides accurate Comprehensive Error Rate Testing (CERT) feedback data that is utilized by the contractor in the development of the IPRS, prioritized problem list and continuous data analysis. F – Control Objective Number F – CUEC Description F.2, F.3 CMS accepts the Monthly Status Reports (MSRs) through its CMS ART System. F.3, F.12 CMS provides Recovery Audit Contractor (RAC) vulnerability reports and findings that are utilized by the contractor in the IPRS, prioritized problem list and continuous data analysis. F.1, F.2, F.3 and F.10 CMS reviews and approves the Improper Payment Reduction Strategy (IPRS) through its CMS ART System prior to the beginning of each contract year. F.4 CMS provides the mechanism for posting Local Coverage Determinations and Articles that are developed by the Contractor Medical Directors (CMD) and policy staff. ALL CMS regularly communicates and makes available Change Requests (CRs), Technical Direction Letters (TDLs) and Medicare rules and regulations to the contractor. ALL Access to the all CMS systems are restricted by user identifier (ID) and password. Inactive ID’s are suspended after 30 calendar days and deleted after 90 calendar days. Controls are in place to suspend an account after three unsuccessful login attempts End Section 30.9.3 – F CUECs – Medical Review (MR): Back to Table of Contents