Policy & Review Programs
LCDs / Medical Policy
Find news about local and national coverage determinations, learn how to search the Medicare coverage database, use the procedure/diagnosis code lookup tool, and review clinical trials.
Medical Review
Medical Review focuses on identification of aberrancies or patterns of inappropriate billing, educating providers on Medicare coverage and coding requirements, and review of claims and documentation. Learn more about this process including the Targeted Probe and Educate program.
Prior Authorization
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 alert the submitter of any potential issues with the submitted information.
Provider Audit & Reimbursement
Part A providers: Find details regarding provider audit and reimbursement, including cost report filing instructions, rate and reimbursement details, wage index, and more.
CERT
CMS established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. View this page to learn more about this program.