The Healthcare Provider's #1 Medicare Audit Defense & Medicare Appeals Resource
Medicare Audit Defense & Compliance - RAC Appeals - ZPIC Appeals - CMS Program Integrity Resources

The 2011 Medicare Audits & Medicare Appeals Guide is highlighted, sorted and organized by Medicare audit focus area.  With over 10,000 CMS resource documents, the Guide includes the nation's most comprehensive resource of Medicare audit & Medicare appeals tools, policies, procedures, presentations, legislation & regulations.  There simply is no better resource to understanding and receiving insight to current CMS efforts to stop Medicare fraud & abuse!

Sample - 2011 Medicare Audits & Medicare Appeals Focus Areas

    Short Stays - Chest Pain and Chest Pain Related Diagnoses
    Extensive O.R. Procedures Unrelated to PDX
    Respiratory Care Diagnoses with Ventilator MS-DRGs
    Excisional Debridement Impacted MS-DRGs
    PCI / Implantable Cardioverter Defibrillators (ICDs)
    Inpatient Rehabilitation Facility Admissions
    Skilled Nursing Facility Admissions
    Outpatient Physical Therapy Encounters
    Emergency Room Visits and use of Modifier 25
    Hospice Admissions and Certifications
    Evaluation & Management Coding
    
Sample - 2011 Medicare Audits & Medicare Appeals Guide Documents

    Jackson Davis HealthCare Medicare Audits & Medicare Appeals Continuing Education Programs
    CMS - Recovery Audit Contractor (RAC) Transmittals
    CMS - Medicare Benefit Policy Manual
    CMS - Medicare Claims Processing Manual
    CMS - National Coverage Determinations
    CMS - Local Coverage Determinations
    CMS - Widespread, Targeted & Statewide Probes
    CMS - UB-04 Billing Manuals
    CMS - Charge Compression & Rate Structure Transmittals
    CMS - RAC Focus Area Audit Tools & Methodologies
    CMS - Medicare Cost Report (audit tools, policies procedures & presentations)
    CMS - RAC Appeals Process
    QIO - Medical Review (audit tools, policies & procedures)
    QIO - Sample Medicare Focus Area Clinical Documentation

There simply is no better documented resource for assessing critical Medicare audit areas, evaluating & implementing Medicare coverage criteria, addressing potential Medicare fraud or abuse and preparing cost-effective, timely, comprehensive & defensible Medicare appeals.