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Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded, and medically reasonable and necessary.
This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for critical care services.
CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
This article has been revised to include instructions for completing the PAR, the PAR review and decision process, guidance on multiple or staged procedures, as well as best practices, tips and reminders related to the PAR.
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…
Review this checklist to learn about the documentation requirements for medical professionals related to the repetitive, scheduled, non-emergency prior authorization program.