Pub 100-08 Medicare Program Integrity: Clinical Review Judgment (CRJ)
Guidance that proposes clarifying CRJ language that directs Medicare claim review contractors to use CRJ while performing complex reviews of claims and medical documentation submitted by providers. CRJ is not to be used to assume facts not in evidence in the medical record, nor can CRJ supersede any policy or regulation.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 14, 2010
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