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Medicare Fee-for-Service Compliance Programs

The Medicare Fee-for-Service Compliance programs prevent, reduce and measure improper payments in FFS Medicare through medical review.  Links to the various programs can be found on the left side of this page. 

CMS will soon launch an 18-month pilot program whereby providers practicing within certain Advanced Alternative Payment Models (APMs) will be relieved of medical record reviews under certain medical review (MR) programs.  

To see some Frequently Asked Questions about the pilot, click on the link below called "APM Medical Review FAQs."  

To see the press release about the pilot, please go to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases.html.    

To see a fact sheet further describing the pilot, please go to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets.html

Prior Authorization Lookup Service

Use the Prior Authorization Lookup Service to determine if Medicare Fee-for-Service requires Prior Authorization for certain items or services in your state.

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