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Who / what is a recovery auditor?
CMS established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. View t…
View instructions on completing the CMS-20134 enrollment application.
Access tools and forms related to the prior authorization program, CERT, and provider audit.
This edition includes information on fiscal year 2026 final payment rules.
View these guidelines for completing the CMS-855A enrollment application for Part A institutional providers.
This edition includes information on crushing fraud, preventing E/M claim denials, a CMS listening session, and more.
Medical decision-making (MDM) is one of the key components used to determine the level of service for Evaluation and Management (E/M) coding. Since 2021, the American Medical Association (AMA) and CMS have emphasized MDM (or time) as the pr…
This edition includes information on critical access hospitals, seasonal flu vaccine pricing for 2025-2026, nursing home care compare updates, and more.
Breaking news for critical access hospitals (CAHs): CMS has directed MACs to immediately turn off reason codes 31006 and 31007 to give providers time to submit all method II reassignments to their Part A CAHs promptly. Read further to learn…