(Medicare Program Integrity Manual)

06/21/2018  Use of Accessible and Applicable Claims History During Medical Review  07/24/2018  10640  R791PI  04/27/2018  Restoring Section 3.2.3 B. and Section 3.2.3 C. to Chapter 3 of Publication (Pub.) 100-08 in the In ternet Only Manual (IOM)  05/29/2018  10505  R786PI  04/13/2018  Reimbursing Providers and Health Information Handlers (HIHs) for Additional Documentation  05/14/2018  10529  R768PI  02/08/2018  Post-Payment Review Timeliness Requirements  04/01/2018  9990  R755PI  11/09/2017  Tracking Medicare Contractors' Prepayment and Postpayment Reviews  12/11/2017  10177  R751PI  10/20/2017  Clarifying Signature Requirements  11/20/2017  10322  R748PI  10/13/2017  Defending Medical Review Decisions at Administrative Law Judge (ALJ) Hearings  11/14/2017  10226  R738PI  08/18/2017  Provider Error Rate Formula  09/19/2017  10210  R732PI  07/21/2017  Clarifying the Instructions for Amending or Correcting Entries in Medical Records  08/22/2017  10120  R721PI  06/09/2017  Elimination of Routine Reviews Including Documentation Compliance Reviews and Instituting Three  Medical Reviews  07/11/2017  9809  R713PI  05/05/2017  Scribe Services Signature Requirements  06/06/2017  10076  R698PI  01/20/2017  The Process of Prior Authorization  02/21/2017  9940  R674PI  09/02/2016  Duplicate Postpayment Claim Reviews  11/04/2016  9665  R663PI  07/15/2016  Denial Codes for Missing or Insufficient Documentation  08/16/2016  9690  R657PI  06/17/2016  Special Provisions for Lab Additional Documentation Requests (ADRs)  07/18/2016  9670  R634PI  01/22/2016  Reviewers' Credentials, Notifying the Provider, CARC Code Update  04/22/2016  9333  R628PI  12/04/2015  Update to CMS Publication 100 -08, Chapter 3, Section 3.2.3.2 (Time Frames for Submission)  01/06/2016  9438 R620PI  10/16/2015  Pub. 100 -08 Chapter 3 Updates: Section 3.2.3.2 Timeframes for Submission and Section 3.2.3.8 - No response to Additional 11/17/2015  9226  Rev #  Issue Date  Subject  Impl Date  CR#  Documentation Requests  Rescinded and not replaced  R617PI  10/09/2015  Update to Chapter 3 of Pub. 100 -08 11/10/2015  9303  R615PI  10/02/2015  Signature Requirements  11/02/2015  9332  R613PI  09/25/2015  Postpayment Review Requirements  10/26/2015  9323  R608PI  08/14/2015  Update to Pub. 100 -08 to Provide Language -Only Changes for Updating ICD-10 and ASC X12  09/14/2015  8747  R604PI  07/24/2015  Signature Requirements  08/25/2015  9225  R585PI  04/03/2015  Coding Determinations  05/04/2015  8937  R568PI  02/04/2015  Review Timeliness Requirements for Complex Review  03/01/2015  8443  R567PI  02/04/2015  New Timeframe for Response to Additional Documentation Requests  04/06/2015  8583  R566PI  01/07/2015  New Timeframe for Response to Additional Documentation Requests  Rescinded and replaced by Transmittal  567 04/06/2015  8583  R565PI  12/31/2014  Update to CMS Publication 100 -08, Chapter 3, Section 3.2.3.2 (Time Frames for Submission)  02/02/2015  9012  R557PI  11/26/2014  Update to CMS Publication 100 -08, Chapter 3, Section 3.2.3.4 (Additional Documentation Request Required and Optional Elements)  12/29/2014  8948  R554PI  11/14/2014  New Timeframe for Response to Additional Documentation Requests  Rescinded and replaced by Transmittal 566  04/06/2015  8583  R547PI  10/17/2014  Review Timeliness Requirements for Complex Review  Rescinded and replaced by Transmittal 566  02/24/201 5 8443  R543PI  09/26/2014  Defending Medical Review Decisions at Administrative Law Judge (ALJ) Hearings  10/27/2014  8501  R541PI  09/12/2014  Claims that are Related  09/08/2014  8802  R540PI  09/04/2014  Claims that a re Related  Rescinded and replaced by Transmittal 541  09/08/2014  8802  R534PI  08/08/2014  Claims that are Related  Rescinded and replaced by Transmittal 540  09/08/2014  8802  R527PI  07/03/2014  Provider Notice on MAC Web sites  09/05/2014  8690  Rev #  Issue Date  Subject  Impl Date  CR#  R523PI  04/20/2014  Update to CMS Pub. 100 -08, Chapter 3  Rescinded and not replaced  07/22/2014  8791  R512PI  04/18/2014  Revision to the Program Integrity Manual, Chapter 3 Section 3.3  05/19/2014  8716  R505PI  02/05/2014  Removing Prohibition - Rescinded  03/06/2014  8425  R501PI  01/09/2014  Complex Medical Review  10/07/2013  8429  R500PI  12/27/2013  Third -party Additional Documentation Request CERT Update  01/28/2014  8547  R498PI  12/27/2013  Notifying the Provider of Postpayment Review Results  01/28/2014  8541  R496PI  12/12/2013  Tracking Medicare Contractors' Postpayment Reviews  10/03/2013  8362  R489PI  10/18/2013  100% Prepayment Review and Random Review Instructions  11/19/2013  8427  R488PI  09/20/2013  Acceptable Submission Methods for Responses to ADRs  10/21/2013  8436  R487PI  09/13/2013  Tracking Medicare Contractors' Postpayment Reviews  10/03/2013  8362  R486PI  09/06/2013  Complex Medical Review  Rescinded and replaced by Transmittal 501  10/07/2013  8429  R485PI  08/21/2013  Program Safeguard Contractor (PSC) and Zone Program Integrity Contractor (ZPIC) Provider Notification  01/29/2013  8079  R484PI  08/21/2013  OMB Collection Number  05/21/2012  7750  R477PI  08/02/2013  Tracking Medica re Contractors' Postpayment Reviews  Rescinded and replaced by Transmittal 487  10/03/2013  8362  R465PI  05/17/2013  Use of a Rubber Stamp for Signature  06/18/2013  8219  R464PI  05/17/2013  Reopening Claims with Additional Information or Denied due to Late or No Submission of Requested Information  06/18/2013  8267  R458PI  04/12/2013  EsMD RC Public Announcement  05/13/2013  8208  R455PI  03/15/2013  Progress Notes and Forms  12/10/2012  8033  R453PI  03/13/2013  Progress Notes and Forms  Rescinded and replaced by Transmittal 455  12/10/2012  8033  R447PI  01/18/2013  Medical Review Timeliness Requirements  02/19/2013  8131  R446PI  12/28/2012  Program Safeguard Contractor (PSC) and Zone Program Integrity Contractor (ZPIC) 01/29/2013  8079  Rev #  Issue Date  Subject  Impl Date  CR#  Provider Notification   Rescinded and replaced by Transmittal 485  R442PI  12/07/2012  Update for Amendments, Corrections and Delayed Entries in Medical Documentation  01/08/2013  8105  R438PI  11/09/2012  Progress Notes and Forms  Rescinded and replaced by Transmittal 453  12/10/2012  8033  R426PI  06/15/2012  Process for Handling Electronic Submission of Medical Documentation (esMD)  07/16/2012  7835  R422PI  05/25/2012  Request Records Related to the Claim Being Reviewed  06/26/2012  7837  R418PI  04/20/2012  OMB Collection Number  Rescinded and replaced by Transmittal 484  05/21/2012  7750  R399PI  11/04/2011  Revision of PIM Chapter 3, Section 3.2.1 Setting Priorities and Targeting Reviews  12/05/2011  7622  R398PI  11/04/2011  Revision of PIM Chapter 3, Section 3.7.5, Part B, Corrective Action Reporting on CMS and OIG Identified Vulnerabilities Spreadsheet Submission Instructions  12/05/2011  7479  R396PI  11/02/2011  Medical Review of PWK (paperwork)  04/02/2012  7330  R383PI  08/26/2011  Update to Pub. 100 -08, Medicare Program Integrity Manual -Chapter 3  09/26/2011  7536  R377PI  05/27/2011  Program Integrity Manual Reorganization of Chapters 3 and 8  06/28/2011  6560  R367PI  02/25/2011  Use of Claims History Information in Claim Payment Determination  03/25/2011  7305  R366PI  02/04/2011  Auto Denial of Claim Line(s) Items Submitted with a GZ Modifier  07/05/2011  7228  R360PI  12/10/2010  Corrective Action Reporting  01/12/2011  7241  R343PI  06/18/2010  Medical Review Resolutions in the Absence of a Plan of Care (POC) and the Outcome Assessment Informatio n Set (OASIS)  07/19/2010  6982  R338PI  05/14/2010  Clinical Review Judgment (CRJ)  06/15/2010  6954  R327PI  03/16/2010  Signature Guidelines for Medical Review Purposes  04/16/2010