CMS has updated the Medicare Program Integrity Manual to direct contractors to use Clinical Review Judgments (CRJ) when making complex review determinations about a claim. CRJ involves two steps: (1) the synthesis of all submitted medical record information to create a longitudinal clinical picture of the patient; and (2) the application of this clinical picture to the review criteria to determine whether relevant clinical requirements have been met. CMS specifies that CRJ does not replace poor or inadequate medical record documentation, nor can contractors use CRJ to override or disregard any policy or regulation. The policy is effective April 23, 2010, and will be implemented June 15, 2010.