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The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA) program for certain hospital outpatient department (OPD) services.
View targeted probe and educate (TPE) round results for ambulance services: basic life support non-emergent transport and mileage (HCPCS A0428 and A0425).
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.
Read this article to learn more about CERT reviews for vaccine and roster billed claims.
View this updated listing of targeted probe and educate (TPE) review topics.
View these round results for rehabilitation services outpatient.
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.