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Below you will find information on The Centers for Medicare & Medicaid Services (CMS) Provider Compliance Tips program.

The Provider Compliance Tips [ https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html#Chiropractic ] tool provides high level guidance on how to prevent claim denials and highlight documentation requirements for claim submission. It focuses primarily on services with high improper payment rates and is published by the Center of Medicare (CM) and posted to the Medicare Learning Network (MLN). This educational tool offers Medicare provider compliance tips to help providers order and bill items and services for eligible patients and meet medical necessity requirements.

This Provider Compliance Tips [ https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html#Chiropractic ] tool offers coverage compliance information for different covered services and supplies,  such as:

·       Affected Providers

·       HCPCS & CPT Codes

·       Billing Denials & Preventing Them

·       Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) General Documentation Requirements

·       Lab Test Order Requirements

·       Resources

In September 2023, the provider compliance tip for "surgical dressings [ https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html#Surgical ]" was updated using the latest Medicare Fee-for-Service (FFS) Supplemental Improper Payment Data [ https://www.cms.gov/files/document/2022-medicare-fee-service-supplemental-improper-payment-data.pdf ]. The information updated included the improper payment rates, denial reasons and specific guidance to assist meeting medical necessity requirements including physician evaluation, suitable instruction, treatment plan and monitoring. This tool is an example of a valuable educational and supportive resource on surgical dressings [ https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html#Surgical ] Medicare wants to share its availability with your members.

If you have any questions or interested in learning more about the Provider Compliance Tips tool, please visit the Medicare Learning Network [ https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlngeninfo ] home page.








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