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This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for transitional care management (TCM) services.
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 ambulance services: basic life support non-emergent transport and mileage (HCPCS A0428 and A0425).
Learn about various programs which focus on ensuring Medicare compliance. Topics include: Comprehensive error rate testing (CERT), prior authorization, and targeted probe and educate.
Review the top denial / partial denial reasons and high-level results listed below from each round of JN ESRD TPE reviews.
View targeted probe and educate (TPE) round results for end stage renal disease (ESRD).
View this updated listing of targeted probe and educate (TPE) review topics.
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency department visits TPE round results.
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…
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.