Hosp Case Manag. 2012 Feb;20(2):19-20.
The Centers for Medicare and Medicaid Services (CMS) is pushing its auditors to be more aggressive in reviewing hospital claims. CMS has set targets for how many claims the auditors should review. Auditors are encouraged to use extrapolation for denials when they find a pattern of erroneous claims. CMS has approved more than 570 diagnosis related group (DRGs) for medical necessity review.
医疗保险和医疗补助服务中心（CMS）正在督促其审计人员在审查医院索赔时更积极主动。CMS已设定了审计人员应审查索赔数量的目标。当审计人员发现错误索赔模式时，鼓励他们使用推断法进行拒付。CMS已批准了570多个诊断相关分组（DRG）用于医疗必要性审查。
