Claims compliance and review

Who / what is a recovery auditor? 

Access tools and forms related to the prior authorization program, CERT, and provider audit.

Access tools and forms related to the prior authorization program, CERT, and provider audit.

Learn about other review programs including, recovery audit and fraud and abuse prevention.

Learn about other review programs including, recovery audit and fraud and abuse prevention.

Inpatient hospital short stay patient status reviews for acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities.

Read the fourth quarter edition of the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.

Read the Part A first quarter edition of the CERT Insider's Guide to learn more about claim errors assessed during the CERT review process and ways to mitigate these errors in the future.

The MDS is a tool used for implementing standardized assessment and for facilitating care management in skilled nursing homes and non-critical access hospital swing beds.

The MDS is a tool used for implementing standardized assessment and for facilitating care management in skilled nursing homes and non-critical access hospital swing beds.