decisionhealth Newsletters, Part B News - 2008 Issue 3 (March)
Benchmark of the Week: Ten services eligible for prior determination
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Article Overview
This article explains the prior determination process for Medicare Part B and describes the types of services that may be included when carriers publish eligible lists. It is aimed at physicians, billing staff, and coding professionals who monitor carrier policy updates and fee schedule-based service trends.
Why This Topic Matters
Understanding prior determination helps practices anticipate whether a service may require advance carrier review and stay current with carrier-published eligibility lists tied to physician fee schedule activity.
What You Will Learn
- What prior determination is in the Medicare Part B context
- What broad criteria carriers use to identify services for advance review
- Why carrier publication timelines and eligible-service lists matter to practices
- How benchmark-style summaries can highlight higher-volume office services
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
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