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.
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…
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.
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.
Botulinum toxin injections
Botulinum toxins are potent neuromuscular blocking agents that are useful in treating various focal muscle spastic disorders and excessive muscle contractions, such as dystonia, spasms, and twitches.
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.
Facet joint interventions for pain management
Facet joint interventions may be used in pain management for chronic cervical/thoracic and lumbar/sacral pain arising from the paravertebral facet joints. Imaging guidance (fluoroscopy or CT per code…