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Quality Results Spring - 2017
The Centers for Medicare & Medicaid Services (CMS) five-year CPC+ multi-payer model began in January 2017... Do CMS regulations apply to a commercial contract with QualChoice? If so, how? Yes... Any individual facility charges disallowed by CERiS are
Quality Results Summer - 2016
The Centers for Medicare & Medicaid Services (CMS ... Practices can apply for either track, but CMS will determine practice competencies required for each track... Once the regions are announced by CMS, eligible practices may apply up until September 1
Claims and Payment Information
This policy is intended to be consistent with the guidelines set forth by CMS ... These preventable HACs are subject to a no-payment policy by CMS ... This brings QualChoice policy more closely in line with CMS policy regarding preventable HACs... Global surgi
Medical Management
QualChoice follows the postoperative global periods used by the Centers for Medicare and Medicaid (CMS) ... They include claims processing guidelines referenced by the Centers for Medicare & Medicaid Services (CMS), Publication 100-04, Claims Proces
Quality Results Spring - 2016
Medicare claims received by CMS are now electronically crossed over to QualChoice after Medicare pays their portion
Modifiers
Both providers report on a CMS 1500 form... QualChoice global periods are modeled after those of the Centers for Medicare and Medicaid Services (CMS ... QualChoice follows CMS guidelines when determining if CPT code is eligible for reimbursement for an ass
Miscellaneous
Covered medical services provided by APNs and PAs incident to physician services must meet CMS incident to services standards
Provider/Practice Information and QualChoice Procedures
It is used by Medicare Program Safeguard Contractors, CMS Recovery Audit Contractors, and Medicaid Fraud Control Units in calculating overpayments, and is recommended by the OIG i... For more information regarding the False Claims act, please visit cms