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Medicare Probe Review Guidance

In addition to the multitude of auditing activities and programs that exist, the Medicare Carriers/Medicare Administrative Contractors also conduct medical reviews. Like many other auditing programs, these probe reviews are data driven and are conducted for the purpose of validating potential provider billing errors. The process may include either provider or service specific reviews. The health care providers involved in the reviews will be notified of the review results and will receive possible education. WPS, the Medicare contractor for Illinois, Michigan, Minnesota and Wisconsin, recently published information on its probe reviews. Service-specific probe review results may be accessed on the WPS MR Webpage.

For more information on undertaking compliance or if you need assistance in your audit defense, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or (212) 734-0128, or visit the HLP website.

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