Targeted probe and educate (TPE) round results: Major hip and knee replacement (DRG 470)
Review the top denial / partial denial reasons and high-level results from each round of DRG 470 TPE.
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Targeted probe and educate (TPE) round results: Evaluation and management services – emergency department visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency...
Hepatitis B vaccination
Payment for the hepatitis B vaccine and its administration is only available to Medicare beneficiaries who are at high or...
Breakdown of Common Minimum Data Set (MDS) errors
The MDS is a tool used for implementing standardized assessment and for facilitating care management in skilled nursing homes...
Fast facts: Education on CERT error
This article provides insights into the educational initiatives implemented following the assessment of a CERT error.
Medical necessity requirements for skilled nursing facility (SNF) admissions
This questionnaire is intended to provide health care providers with a reference for use when screening a new patient for a SNF...
End stage renal disease (ESRD): Payment for phosphate binders effective January 1
Effective January 1, phosphate binders are paid as a renal dialysis service under Medicare Part B. Read this article to learn...
E/M: Reviewing amount and/or complexity of data
For the element of medical decision making addressing the amount and/or complexity of data to be reviewed and analyzed, the AMA...
Clinicians: Are you ordering urological supplies for your patients?
Urological supplies are covered as part of the Prosthetic Device benefit as outlined in the Social Security Act § 1861(s)(8)...
Inpatient hospital entitlement changes
When a patient enrolls in or disenrolls from a Medicare Advantage plan during his/her inpatient stay, the following factors will...