Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Articles
Article Type
Category
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient (KX modifier)
View TPE round results for rehabilitation services outpatient (KX modifier).
Checklist: Ambulance
This checklist is intended to provide health care providers with a reference for use when responding to additional documentation...
Targeted probe and educate (TPE) round results: Psychotherapy services (CPT 90832, 90834, 90837)
View TPE round results for psychotherapy services.
Ambulance prior authorization - documentation checklist for medical professionals
Review this checklist to learn about the documentation requirements for medical professionals related to the repetitive...
Prior authorization (PA) program for certain hospital outpatient department (OPD) services - submitting the prior authorization request (PAR)
This article has been revised to include instructions for completing the PAR, the PAR review and decision process, guidance on...
Prior authorization program for repetitive, scheduled non-emergent ambulance transports (RSNAT)
CMS has implemented the prior authorization program for certain repetitive, scheduled non-emergent ambulance transports in...
Fast facts: CERT vaccine and roster billed claims
Read this article to learn more about CERT reviews for vaccine and roster billed claims.
Skin substitute graft for treatment of DFU and VLU lower extremities (15271-15278)
View targeted probe and educate (TPE) round results for 15271-15278.
Part B service-specific review -- hyperbaric oxygen therapy (CPT code 99183)
Summary for hyperbaric oxygen therapy (October 2020).