Medical review activities
Service-specific reviews
First Coast is tasked with preventing inappropriate Medicare payments. One of the ways this is conducted...
Additional review programs
- Recovery audit program: Find out how the recovery audit program utilizes claim reviews to reduce the volume of improper payments...
Compliance & review programs
Learn about various programs which focus on ensuring Medicare compliance. Topics include: Comprehensive error rate testing (CERT...
Response to the severe storms, straight-line winds, and flooding in the state of Texas
CMS announces resources and flexibilities to assist with the public health emergency in the state of Texas.
Targeted probe and educate (TPE) round results: Ambulance services - basic life support non-emergent transport and mileage (HCPCS A0428 and A0425)
View targeted probe and educate (TPE) round results for ambulance services: basic life support non-emergent transport and...
CERT awareness month: Verify your medical records correspondence address
Read this article to learn more about the CERT awareness month campaign focusing on verifying your mailing address.
Paperwork (PWK)
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their...
MLN Connects for July 17, 2025
This edition includes information on preventing claim denials for ostomy supplies, revised ZIP code files for CBSAs, chronic...
Understanding prior authorization (PA) for certain hospital outpatient department (OPD) services
The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA)...