Medical review
Prior authorization program for certain hospital outpatient department services
CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
Targeted probe and educate (TPE) round results: Evaluation and management services – emergency department visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency department visits TPE round results.
Prior authorization program
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…
Targeted probe and educate (TPE) round results: Wound care (CPT 11042 and 11045)
View targeted probe and educate (TPE) round results for wound care (CPT 11042 and 11045).
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient (KX modifier)
View TPE round results for rehabilitation services outpatient (KX modifier).
Targeted probe and educate (TPE) round results: Clinical laboratory services
View targeted probe and educate (TPE) round results for clinical laboratory services.
Targeted probe and educate (TPE) round results: Inpatient rehabilitation facilities (IRF)
Review the targeted probe and educate (TPE) round results for inpatient rehabilitation facility (IRF).
Targeted probe and educate (TPE) round results: Clinical laboratory services
View targeted probe and educate (TPE) round results for clinical laboratory services.
Targeted probe and educate (TPE) round results: Evaluation and management services – initial inpatient care visits and subsequent inpatient care visits
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.