Medical review
Hospital outpatient department (OPD) prior authorization exemption process
On August 1, exempt OPDs will receive an additional documentation request (ADR) for a 10-claim post-pay sample on finalized claims with dates of service on or after January 1, through June 30. Review…
Targeted probe and educate round results: Annual wellness visits (AWV)
Top denial / partial denial reasons and high-level results are listed below from each round of annual wellness visits (AWV) services TPE reviews that have been conducted thus far by Medical Review.
What is fraud and abuse?
Learn the difference between fraud and abuse, recognize common warning signs, and understand your role in preventing improper Medicare billing practices. Review this article for more information.
What is fraud and abuse?
Learn the difference between fraud and abuse, recognize common warning signs, and understand your role in preventing improper Medicare billing practices. Review this article for more information.
Medically necessary services and prior authorization
For any service or item to be covered by Medicare, it must be eligible for a defined Medicare benefit category, be reasonable and necessary for the diagnosis or treatment of illness or injury or to…
Medically necessary services and prior authorization
For any service or item to be covered by Medicare, it must be eligible for a defined Medicare benefit category, be reasonable and necessary for the diagnosis or treatment of illness or injury or to…
Blepharoplasty, eyelid surgery, brow lift, and related services
Blepharoplasty, blepharoptosis repair and brow lift are surgeries that may be performed to improve function or provided strictly for cosmetic reasons. Functional or reconstructive eyelid surgery is…
Prior authorization program for certain hospital outpatient department services
CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
Implantation of spinal neurostimulator
CMS covers the implantation of central nervous system stimulators as a therapy for the relief of chronic intractable pain.
Blepharoplasty, eyelid surgery, brow lift, and related services
Blepharoplasty, blepharoptosis repair and brow lift are surgeries that may be performed to improve function or provided strictly for cosmetic reasons. Functional or reconstructive eyelid surgery is…