Medical review
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.
Targeted probe and educate (TPE) round results: Skilled nursing facility (SNF)
Review the top denial / partial denial reasons and high-level results of SNF TPE round results.
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.
Prior authorization program
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing…
Prior authorization program for repetitive scheduled non-emergent ambulance transports
Background
Submissions
Extended affirmation periods
Targeted probe and educate (TPE) round results: Wound care (CPT 11042 and 11045)
View targeted probe and educate (TPE) round results for wound care (CPT 11042 and 11045).
Targeted probe and educate (TPE) round results: Evaluation and management services – emergency department visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency department 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).
Targeted probe and educate (TPE) round results: Skilled nursing facility (SNF)
Review the top denial / partial denial reasons and high-level results of SNF TPE round results.
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.