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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Understanding the credit balance report
Review the following questions and answers to gain an understanding of credit balance reporting.
ADR (Additional documentation requests)
Find information and resources that will help you properly respond to additional documentation requests within required...
Vein ablation and related services
Vein ablation and related services; some patients may want varicose vein treatment for cosmetic reasons. Medicare does not cover...
Implantation of Spinal Neurostimulator
CMS covers the implantation of central nervous system stimulators as a therapy for the relief of chronic intractable pain.
Panniculectomy, excision of excess skin and subcutaneous tissue (including lipectomy), and related services
Effective for dates of service July 1, 2020, and after, hospital outpatient department (HOPD) providers will need to obtain...
Cervical fusion with disc removal
Effective for dates of service July 1, 2021, and after, hospital outpatient department (HOPD) providers will need to obtain...
Hospital outpatient department (OPD) prior authorization exemption process
Hospital outpatient departments (OPDs) who demonstrate compliance with Medicare coverage, coding, and payment rules related to...
Repetitive scheduled non-emergency ambulance transport prior authorization claims submission guidelines
Follow this instructions to learn how to file a claim once you received the unique tracking number (UTN) related to the prior...
Medicare secondary payer (MSP) billing
Read this article for more information on how to bill claims when Medicare is the secondary payer.