Services

Specific Services

Coverage, Coding, Reimbursement rates for all categories of services including:

• Coverage of drugs that are usually self-administered by the patient;
• Interpretation of Medicare administrative manual and CMS policy decision making
• Review and explain national and local medical review policies and compliance requirements.
• Review medical record documentation applicable to documentation requirements under §1833(e).
• Review claim billing, payment and process of Medicare Administrative Contractors (MACs)
• Review and comment on marketing and promotional tools for a Medicare audience.
• Explain Medicare program rules applicable to hospital outpatient, ambulatory surgery centers, ambulance, physicians, non-physician practitioners, and other providers
• Explain MAC processes including actions of carrier medical directors, medical review, appeals, hearings, administrative law judges, and law enforcement
• Explain the change process for Medicare laws, CMS regulations, rules, and carrier instructions.
• Explain the CPT and HCPCS coding process and related pricing methods.