Which option is NOT listed as one of the three types of Medicare claim reviews?

Which option is NOT listed as one of the three types of Medicare claim reviews?

• A. Automated Review
• B. Front-end Verification
• C. Non-Medical Record Review
• D. Medical Record Review

Answer: (B)

In Medicare claim reviews, the focus is on how the claim data and supporting information are examined after submission. The three review types are: - Automated Review: uses computer-based rules to screen claims for potential errors, inconsistencies, or missing elements, enabling fast, large-volume checks. - Medical Record Review: clinicians or coders review the actual patient chart to confirm that the documentation supports the codes billed and that the services were appropriate and necessary. - Non-Medical Record Review: looks at information outside the medical record—such as demographic data, enrollment/benefits status, and other data integrity checks—to ensure the claim is accurate beyond what the chart shows. Front-end Verification isn’t listed among these review types because it’s typically a pre-submission or data-entry validation step, verifying basic information before the claim is reviewed. It doesn’t involve evaluating documentation or codes after the claim has been submitted.

In Medicare claim reviews, the focus is on how the claim data and supporting information are examined after submission. The three review types are:

• Automated Review: uses computer-based rules to screen claims for potential errors, inconsistencies, or missing elements, enabling fast, large-volume checks.

• Medical Record Review: clinicians or coders review the actual patient chart to confirm that the documentation supports the codes billed and that the services were appropriate and necessary.

• Non-Medical Record Review: looks at information outside the medical record—such as demographic data, enrollment/benefits status, and other data integrity checks—to ensure the claim is accurate beyond what the chart shows.

Front-end Verification isn’t listed among these review types because it’s typically a pre-submission or data-entry validation step, verifying basic information before the claim is reviewed. It doesn’t involve evaluating documentation or codes after the claim has been submitted.