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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.
Blepharoplasty, blepharoptosis repair and brow lift are surgeries that may be performed to improve function or provided strictly for cosmetic reasons. Functional or reconstructive eyelid surgery is performed to improve abnormal function, re…
Claims submitted for a prior authorization request (PAR) that received a provisional affirmation PA decision, including any service that was part of a partially affirmed decision, must include the 14-byte unique tracking number (UTN) number…
Vein ablation and related services; some patients may want varicose vein treatment for cosmetic reasons. Medicare does not cover cosmetic surgery or expenses incurred in connection with such surgery.
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation requests for AWV. Health care providers retain responsibility to submit complete and accurate documentation.
This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for Skilled Nursing Facility (SNF) services.
This checklist is intended as reference to use when responding to additional documentation requests for IRF services.
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for cardiac rehabilitation services.
The Comparative Billing Report (CBR) for Part B providers furnishes a detailed examination of the comparative data that Medicare considers when determining how the provider’s billing patterns contrast with those of other providers of the sa…
Review the top denial/partial denial reasons and high-level results from each round of DRG 226 and 267 TPE.