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Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.
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 the service. The contractor will then al…
Learn about various programs which focus on ensuring Medicare compliance. Topics include: Comprehensive error rate testing (CERT), prior authorization, and targeted probe and educate.
View targeted probe and educate (TPE) round results for wound care (CPT 11042 and 11045).
Medicare home health referrals must contain information in the medical record from the certifying physician and/or acute/post-acute care facility justifying the referral. Use this checklist to gain an understanding of the criteria necessary…
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation requests for surgical services: cataract extraction.
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation requests for chronic care management (CCM) services.
This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for Ambulance transports.
Review the top denial / partial denial reasons and high-level results of evaluation and management services - initial inpatient care visits and subsequent inpatient care visits TPE round results.
View targeted probe and educate (TPE) round results for 15271-15278.