Fraud, Waste & Abuse
Compliance
Claims, Pricers & Codes
MLN Matters® Articles
Publications & Multimedia
Fraud, Waste & Abuse
Ambulatory Surgical Centers: Prior Authorization Pilot Demonstration
As part of our efforts to crush fraud, CMS will launch a new prior authorization demonstration this December to address certain cosmetic services in Ambulatory Surgical Centers. Visit the Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services webpage to learn more and to see if your state is included in the demonstration.
Compliance
DME: Complying with Proof of Delivery Requirements
The Comprehensive Error Rate Testing (CERT) Task Force identified missing or incomplete proof of delivery (POD) documents for DME claims. You’re required to maintain POD documentation for 7 years from the date of service regardless of your delivery method.
Use the CERT DME POD Requirements (PDF) work guide to learn what you must include and what’s required for each delivery method.
More Information:
- Standard Documentation Requirements for All Claims Submitted to DME MACs article
- Medicare Program Integrity Manual, Chapter 4 (PDF), section 4.7.3.1.1–4.7.3.1.3
- CERT webpage
Claims, Pricers & Codes
National Correct Coding Initiative: October Update
Get the National Correct Coding Initiative (NCCI) fourth quarter edit files effective October 1, 2025, on these Medicare NCCI webpages:
MLN Matters® Articles
Implementing the Transforming Episode Accountability Model: Skilled Nursing Facility 3-Day Rule Waiver
Learn about details, participation, and payment (PDF) for the new Transforming Episode Accountability Model (TEAM) running from January 1, 2026 – December 31, 2030, including:
- CMS will allow acute care hospitals who participate in the model to discharge patients without a 3-day hospital stay to a qualified skilled nursing facility (SNF) or swing bed provider, including a critical access hospital
- The patient must meet the eligibility criteria for TEAM and have a qualifying outpatient procedure or hospital inpatient stay prior to admission to the SNF
- The admission date to the SNF must happen no later than 30 days after the hospital or outpatient department discharges the patient
- We’ll pay for services when the SNF claim meets certain payment criteria, including submitting the claim with the required TEAM demonstration code A9
Publications & Multimedia
Complying with Medicare Signature Requirements Revised
CMS added information (PDF) on:
- Stamped signatures
- Artificial intelligence
- Signature attestations and logs
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