How to Determine Provider Error Rate

August 28, 2017
Rick Gawenda

When providers of therapy services have medical records audited by their Medicare Administrative Contractor (MAC) and one or more services are denied, the MAC will determine the providers error rate and this error rate could determine whether additional medical records will be requested for review. So how does the MAC determine the error rate?

The error rate is determine 1 of 2 ways dependent upon if it is a prepayment medical review or postpayment medical review. For a prepayment review, the error rate is determined by

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