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CMS is implementing a five-year demonstration project for the prior authorization of certain services provided in Ambulatory Surgical Centers (ASCs) and will be implementing the demonstration in two phases.
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 Ambulance transports.
This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for endovascular cardiac valve replacement and supplement procedure (DRG 266 and 267).
View this summary for outpatient rehabilitation services (August - November 2020 and August 2021).
View this summary for psychotherapy services (December 2020 - March 2021).
TPE is one process that a MAC can utilize when providers are selected by medical review.
Review the targeted probe and educate (TPE) round results for inpatient rehabilitation facility (IRF).
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.