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This document outlines a change request regarding the automatic denial of claim line items submitted with a GZ modifier, specifying that these claims shall not be subject to complex medical review
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The CMS Manual System is a comprehensive documentation system established by the Centers for Medicare & Medicaid Services (CMS) that provides guidelines, policies, and procedures for the administration of Medicare and Medicaid programs.
Entities that participate in Medicare and Medicaid programs, including healthcare providers, suppliers, and organizations that provide services to beneficiaries, are required to file and adhere to the CMS Manual System.
To fill out the CMS Manual System, entities must follow the specific guidelines outlined in the manual, including providing accurate information related to services rendered, patient care, billing procedures, and compliance with federal regulations.
The purpose of the CMS Manual System is to ensure that healthcare providers comply with regulations, improve the consistency and quality of care provided to Medicare and Medicaid beneficiaries, and facilitate effective management of healthcare programs.
Information to be reported on the CMS Manual System includes details about healthcare services provided, patient demographics, billing information, compliance with regulations, and documentation of medical necessity.
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