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.