Hello, my Name is Meg Murphy and I’m the Supervisor of the Professional and Policy Staff in Medical Review. I feel that my most important job is to ensure that claims get paid correctly. Claims processed by Empire Medicare Services are subject to review by an independent contractor as part of a CMS directed program called CERT (Comprehensive Error Reduction Program) and we as a carrier receive errors on any claim that has been determined by CERT to be processed incorrectly.

Twice a year a National Error Rate is established for all Medicare Carriers. My goal is to reduce Empire’s error rate to the lowest possible percentage. This is accomplished by having a staff of nurses who not only have extensive clinical backgrounds, are also recognized by the American Academy of Coders as Professional Coders. In order to keep the Professional Staff up to date with the most current Local Coverage Determinations, CMS Guidelines and emerging medical technologies, monthly meetings are held with the Carrier Medical Directors. When needed, meetings with Specialty Physicians are also held.

Not only is it important that the Professional staff has the clinical knowledge they need to review claims, providers also need to know what the Medicare requirements are for billing services. That’s why education is provided to providers with identified problems on all relevant policies and guidelines by the Professional Staff. When necessary, the Carrier Medical Director and/or Consultant are involved in the educational process.

The importance of having claims paid correctly cannot be stressed enough. By paying claims correctly, the Medicare Trust Fund is protected and Medicare beneficiaries can be ensured that any Medicare service they receive will be billed correctly.

Thank you for visiting me on line. Please feel free to contact our website for information on “What’s New in Medical Review.”