Post-payment service-specific reviews
Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded, and medically...
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Prior authorization tips and reminders
The PA team has been receiving and processing prior authorization requests (PAR) for certain hospital OPD services. View the...
Skilled nursing facility (SNF) 5-claim probe and educate (P&E) round results
View this article to view the results for the SNF 5-claim probe and educate (P&E).
Prior authorization (PA) for hospital outpatient department (OPD) services: tips and reminders
The following are tips and reminders that will assist providers in avoiding a delay or dismissal of a prior authorization...
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...
Prior authorization program for certain hospital outpatient department services - claim submission guidelines
Claims submitted for a prior authorization request (PAR) that received a provisional affirmation PA decision, including any...
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.
ADR (Additional documentation requests)
Find information and resources that will help you properly respond to additional documentation requests within required...
Implantation of Spinal Neurostimulator
CMS covers the implantation of central nervous system stimulators as a therapy for the relief of chronic intractable pain.
Hospital outpatient department (OPD) prior authorization exemption process
Hospital outpatient departments (OPDs) who demonstrate compliance with Medicare coverage, coding, and payment rules related to...