Hospital outpatient department (OPD) prior authorization exemption process
On August 1, exempt OPDs will receive an additional documentation request (ADR) for a 10-claim post-pay sample on finalized...
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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...
Medical review activities
Service-specific reviews
First Coast is tasked with preventing inappropriate Medicare payments. One of the ways this is conducted...
Prior authorization (PA) demonstration for certain ambulatory surgical center (ASC) services
CMS is implementing a five-year demonstration project for the prior authorization of certain services provided in Ambulatory...
Targeted probe and educate (TPE) round results: Skilled nursing facility (SNF)
Review the top denial / partial denial reasons and high-level results of SNF TPE round results.
Targeted probe and educate round results: Annual wellness visits (AWV)
Top denial / partial denial reasons and high-level results are listed below from each round of annual wellness visits (AWV)...
Medical documentation checklists
Use these checklists to ensure you have met medical documentation requirements based on specific services.
Targeted probe and educate (TPE) round results: Wound debridement (CPT 11042-11045)
Review the top denial/partial denial reasons and high-level results of wound debridement (CPT 11042-11045) TPE round results for...
Targeted probe and educate (TPE) topics and schedule of review
View this updated listing of targeted probe and educate (TPE) review topics.
Targeted probe and educate (TPE) round results: End stage renal disease (ESRD) (CPT 90999)
Review the top denial / partial denial reasons and high-level results listed below from each round of JN ESRD TPE reviews.