Medical review
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 Surgical Centers (ASCs) and will be implementing the demonstration in two…
Understanding the prior authorization (PA) demonstration for ambulatory surgical center (ASC) services
This document was developed based on questions and answers posed during our webinars on the PA demonstration for ASC services.
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Targeted probe and educate (TPE) round results: Evaluation and management services - outpatient office visits
View TPE round results for evaluation and management services - outpatient office visits.
Targeted probe and educate (TPE) round results: Evaluation and management services - outpatient office visits
View TPE round results for evaluation and management services - outpatient office visits.
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient (KX modifier)
View TPE round results for rehabilitation services outpatient (KX modifier).
Targeted probe and educate (TPE) round results: Evaluation and management services – initial inpatient care visits and subsequent inpatient care visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services - initial inpatient care visits and subsequent inpatient care visits TPE round results.
Targeted probe and educate (TPE) round results: Evaluation and management services – initial inpatient care visits and subsequent inpatient care visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services - initial inpatient care visits and subsequent inpatient care visits TPE round results.
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient (KX modifier)
View TPE round results for rehabilitation services outpatient (KX modifier).