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MLN Provider Compliance

The Medicare Learning Network

Fast Fact

Per Medicare’s National Coverage Determination (NCD), NCD 220.1, CT scans must be medically appropriate considering the patient’s symptoms and preliminary diagnosis. Local Coverage Determinations (LCDs) for CT scans further define the circumstances demonstrating medical necessity.

Documentation must be available to Medicare upon request. CT scans had an improper payment rate of 16 percent during the most recent reporting period for the Comprehensive Error Rate Testing (CERT) program.  For more information, please refer to the Medicare Learning Network® (MLN) fact sheet, “Provider Compliance Tips for Computed Tomography (CT Scans)“.

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The Medicare Learning Network® (MLN) Provider Compliance page contains educational products that inform health care professionals on how to avoid common billing errors and other improper activities when dealing with various CMS Programs. CMS’ claim review program’s overall goal is to reduce improper payment error by identifying and addressing coverage and coding billing errors. Since 1996, CMS has implemented several initiatives: to prevent improper payments before a claim is processed; and to identify, and recoup improper payments after the claim is processed.

The Downloads section contains MLN products, MLN Matters® Articles, and the “Archive of Medicare Quarterly Provider Compliance Newsletters” which have been designed to provide education on common billing errors and other improper activities. These lists, as well as other information in the Downloads and Related Links section, are updated as new products and articles are developed and existing products and articles are revised.

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