What is the primary software used by CMS for Automated Review?

What is the primary software used by CMS for Automated Review?

• A. HIPAA Editor
• B. Medicare Code Editor (MCE)
• C. CPT Code Validator
• D. ICD-10 Editor

Answer: (B)

CMS automated review relies on the Medicare Code Editor, which runs automated edits on submitted claims to verify that codes, modifiers, and their relationships conform to CMS rules and payer policies. It serves as the primary tool for prepayment checks, catching coding inaccuracies before payment is issued. The HIPAA Editor isn’t used for automated review in this context, and while CPT Code Validator or ICD-10 Editor exist in related coding workflows, they are not the main CMS tool for automated review. Therefore, the Medicare Code Editor is the best answer.

CMS automated review relies on the Medicare Code Editor, which runs automated edits on submitted claims to verify that codes, modifiers, and their relationships conform to CMS rules and payer policies. It serves as the primary tool for prepayment checks, catching coding inaccuracies before payment is issued. The HIPAA Editor isn’t used for automated review in this context, and while CPT Code Validator or ICD-10 Editor exist in related coding workflows, they are not the main CMS tool for automated review. Therefore, the Medicare Code Editor is the best answer.