CMS Provides Further Clarification On The Manual Medical Review Process for 2013

On March 21, 2013, the Centers for Medicare and Medicaid Services (CMS) released additional guidance on manual medical review for outpatient therapy services exceeding $3,700 in calendar year 2013. This applies to all Part B outpatient therapy settings except critical access hospitals. Medicare Administrative Contractors (MACs) will conduct prepayment review on claims reaching the $3,700…

Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain Medicare Solutions Policy Summary

From UnitedHealthcare March 2013 Network Bulletin CMS issued National Coverage Determination (NCD) 160.27 Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) effective June 8, 2012, limiting coverage of TENS for CLBP to members who are enrolled in a CMS approved clinical trial and meet certain criteria. When coverage requirements are met original…