(Medicare Program Integrity Manual)

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for Medical Review Purposes  04/16/2010  6698  R303PI  09/25/2009  Local Coverage Determinations (LCD) Exceptions - Rescinded  10/13/2009  6586  R302PI  09/11/2009  Local Coverage Determinations (LCD) Exceptions - Rescinded and replaced by Transmittal 303  10/13/2009  6586 Rev #  Issue Date  Subject  Impl Date  CR#  R282PI  01/08/2009  Zone Program Integrity Contractor (ZPIC) Updates  01/26/2009  6170  R278PI  12/19/2008  Zone Program Integrity Contractor (ZPIC) Updates - Rescinded and replaced by Transmittal 282  01/26/2009  6170  R264PI  08/07/2008  Transition of Responsibility for Medical Review From Quality Improvement Organizations (QIOs)  08/15/2008  5849  R248PI  03/28/2008  Signature Requirements Clarification  04/28/2008  5971  R245PI  02/29/2008  Processing Part B Therapy Claims While the Therapy Cap Exceptions Process is in Effect  03/31/2008  5945  R220PI  08/24/2007  Various Medical Review Clarifications  09/03/2007  5550  R185PI  01/26/2007  Updating Financial Reporting Requirements for Workload and Cost Associated With the Return of Demand Bills  02/26/2007  4378  R184PI  01/26/2007  Revisions for MACs and PSCs  02/26/2007  5399  R181PI  12/29/2006  Outpatient Therapy Cap Exceptions Process for Calendar Year (CY) 2007  01/29/2007  5478  R179PI  12/15/2006  Revised Medical Review Timeliness and Reopening Requirements for Medical Review  01/16/2007  5252  R174PI  11/17/2006  Transition of Medical Review Educational Activities  10/06/2006  5275  R171PI  11/09/2006  Outpatient Therapy Cap Clarifications  12/09/2006  5271  R170PI  11/03/2006  Transition of Medical Review Educational Activities  Replaced by Transmittal 174  10/06/2006  5275  R167PI  10/27/2006  New DMEPOS Certificates of Medical Necessity (CMNs) and DME  Information Forms (DIFS) for Claims Proces sing 10/01/2006  4296  R163PI  09/29/2006  Transition of Medical Review Educational Activities  Replaced by Transmittal 170  10/06/2006  5275  R159PI  09/22/2006  New DMEPOS Certificates of Medical Necessity (CMNs) and DME  Information Forms (DIFS) for Claims Proces sing - Replaced by Transmittal 167  10/02/2006  4296  R149PI  06/30/2006  Notification to Providers, Suppliers, and Beneficiaries of Postpayment Review Results  07/31/2006  5115  Rev #  Issue Date  Subject  Impl Date  CR#  R142PI  03/02/2006  New DMEPOS Certificates of Medical Necessity (CMNs) and DME MAC Information Forms (DIFS) for Claims Processing  Replaced by Transmittal 159  10/02/2006  4296  R140PI  02/15/2006  Therapy Caps Exception Process  03/13/2006  4364  R139PI  02/13/2006  Therapy Caps Exception Process - Replaced by Transmittal 140  03/13/2006  4364  R138PI  02/10/2006  New DMEPOS Certificates of Medical Necessity (CMNs) and DME MAC Information Forms (DIFS) for Claims Processing - Replaced by Transmittal 142  10/03/2006  4296  R135PI  01/06/2006  Changes to the GTL Titles  02/06/2006  4228  R131PI  10/10/2005  Medical Review Matching of Electronic Claims and Additional Documentation in the Medical Review Process  02/10/2006  4052  R125PI  09/30/2005  Medical Review Additional Documentation Requests  12/30/2005  4022  R123PI  09/23/2005  MMA Section 935  10/24/2005  3703  R122PI  09/16/2005  Medical Review Collection Number Requirements  10/17/2005  4091  R120PI  08/25/2005  Correction to Change Request (CR) 3222: Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision  N/A 3880  R118PI  08/12/2005  Various Benefit Integrity (BI) Clarifications  09/12/2005  3896  R114PI  06/10/2005  Change in Statistical Sampling Instructions  05/31/2005  3734  R108PI  04/29/2005  Change in Statistical Sampling Instructions  05/31/2005  3734  R100PI  01/21/2005  Review of Documentation During Medical Review  02/22/2005  3644  R098PI  01/21/2005  Psychotherapy Notes  02/22/200 5 3457  R096PI  01/14/2005  Consent Settlements  02/14/2005  3626  R094PI  01/14/2005  Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determinatio n (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial  07/05/2005  3602  R091PI  12/10/2004  Revision of Program Integrity Manual (PIM), Section 3.11.1.4  01/03/2005  3560  R090PI  12/10/2004  Prepayment Re view of Claims for MR 01/10/2005  3569  Rev #  Issue Date  Subject  Impl Date  CR#  Purposes  R087PI  11/05/2004  Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial  04/04/2005  3363  R086PI  11/05/2005  Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Ser vices  11/22/2004  3437  R85PI  10/22/2004  Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial - Replaced by Transmittal 87  04/04/2005  3363  R084PI  10/22/2004  Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Services - Replaced by Transmittal 86  11/22/2004  3437  R079PI  07/09/2004  Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision; Denial Notices  08/09/2004  3222  R076PI  05/28/2004  Clarification of Complex Medical Review  06/28/2004  3211  R075PI  05/14/2004  Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial  10/04/2004  3089  R072PI  04/16/2004  Automated  Prepayment Review  05/01/2004  3088  R071PI  04/09/2004  Rewrite of Program Integrity Manual (except Chapter 10) to Apply to PSCs  05/10/2004  3030  R070PI  04/09/2004  New Requirements for Self -Administered Drug (SAD) Exclusion List Articles in the Medicare Coverage Database (MCD)  05/10/2004  3136  R066PI  02/20/2004  Progressive Corrective Action Program Memorandum and Updated Instructions on How Contractors Must Identify, Verify, and Correct Billing Errors  04/02/2004  3124  R064PI  01/30/2004  Role Conditions of Participation (COPs) Requirements When Making a Payment 03/02/2004  3042  Rev #  Issue Date  Subject  Impl Date  CR#  Decision  R059PI  11/28/2003  Documentation Specifications for Areas Selected for Prepayment or Postpayment MR  01/05/2004  2937  R054PI  10/31/2003  Denia l Notices  04/05/2004  2936  R053PI  10/31/2003  Prepayment Edits  04/05/2004  2916  R049PI  09/26/2003  Changing the Use of Remittance Advice Code N109 From Mandatory to Contractors Discretion  10/10/2003  2873  R047PI  07/25/2003  CMS Mandated Edits  08/08/2003  2517  R046PI  07/25/2003  Prepayment Edits  08/01/2003  2681  R039PI  03/14/2003  MR Review and Documentation  04/01/2003  2417  R038PI  02/03/2003  When Contractors May Publish Coverage/Coding Articles In Their Bulletins And Web Sites  02/14/2003  2120  R035PI  11/29/2002  Types of Prepayment and Postpayment Review  01/01/2003  2418  R033PI  11/01/2002  FY 2003 Budget Performance Requirements  11/01/2002  2407  R032PI  10/25/2002  Consent Settlements, CMPs Delegated to CMS and Referrals to OIG  10/25/2002  2333  R031PI  10/25/2002  Revised Prepayment Edits  09/01/2002  1793  R017PIM  12/12/2001