On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-4201-F) regarding the Medicare Advantage (MA) and Part D programs. The Final Rule includes changes related ...

Medicare limits coverage to treatments, services, and supplies deemed medically necessary. If Medicare does not consider a service medically necessary, it will typically not cover it. Medicare covers ...

If you have a bacterial infection, you need to take antibiotics. If health care providers need to determine that you have a broken bone, you’ll need to have an X-ray. Those are some examples of ...

On September 26, 2024, the Centers for Medicare & Medicaid Services’ (CMS) Durable Medical Equipment (DME) Medicare Administrative Contractors (DME MACs), Noridian Healthcare Solutions, LLC and CGS ...

As recovery audit contractors set their sites on medical necessity of inpatient stays, hospitals enter a hazy area of compliance. RAC consultants say Medicare definitions of what constitutes inpatient ...

The Recovery Audit Contractor (RAC) is approaching. Where should your hospital's leadership focus its time and attention? The answer is medical necessity, because it's clearly a key RAC target.

Two recent publications issued by CMS clearly indicate that the organization is tightening its requirements for the documentation required to support medical necessity and mandated signatures on ...

Q: What’s new with wound care documentation and CMS guidelines? A: The Center for Medicare & Medicaid Services recently issued modifications in Local Coverage Determinants that can potentially affect ...