Manual Medical Review
man-yoo-uhl MED-i-kuhl ree-VYOO
A process used by Medicare and other insurers in which medical claims exceeding certain thresholds or flagged for exceptions are reviewed by a person, rather than processed automatically, to determine whether services are reasonable and necessary.
The attorney advised the client that their physical therapy claims were subject to manual medical review because they exceeded Medicare’s annual cost threshold.
Manual medical review is important in healthcare law and insurance disputes. It often arises in cases involving Medicare coverage, rehabilitation services, or long-term treatment plans. Legal professionals may encounter it when appealing denied claims, preparing evidence to show medical necessity, or advising providers on compliance with reimbursement rules.