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A national coverage determination (NCD) [1] is a United States nationwide determination of whether Medicare will pay for an item or service. [2] It is a form of utilization management and forms a medical guideline on treatment.
The National Correct Coding Initiative (NCCI) is a Centers for Medicare & Medicaid Services (CMS) program designed to prevent improper payment of procedures that should not be submitted together. There are two categories of edits:
The acronym HCPCS originally stood for HCFA Common Procedure Coding System, a medical billing process used by the Centers for Medicare and Medicaid Services (CMS). Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA).
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
The Accreditation process follows a three-year accreditation cycle. The process allows for organizations to learn best practices to better serve its client base. The accreditation process starts with the organization looking at their policies and procedures and adding them to the Preliminary Evidence Report (PER) for ACHC to review.
Medicare can be weird: Sometimes, bad news for beneficiaries can actually be good news. That’s the case for certain people who’ll be shopping for a 2025 Medigap policy during Medicare’s Open ...
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