Mission: Possible Seminar Resources

Mission: Possible Resources

Welcome to the exclusive resources page for the Mission: Possible educational series. This page is your gateway to a curated collection of valuable resources and insights that build on the knowledge shared during our seminars. Here, you will find helpful links covering regulatory and compliance areas, as well as those frequently used in our clinical reviews for Medicare and Medicare Advantage encounters. Additionally, explore bios of some of our panelists to get to know them better. Access this page anytime to leverage our expertise, transforming post-appeal challenges into opportunities and ensuring every recovery mission is a resounding success.

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Meet the Mission: Possible Team

• Get to know our more about the Attorneys featured in the panel and simulated arbitration HERE.
• Meet Traci Adair – An executive at SAC and featured as part of our expert panel.
• Meet Tamara Nagrodski – A Clinical Review & Analytics Specialist at SAC and featured as part of our expert panel.

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Regulatory & Compliance Resources:

• All Plan letters from the Department of Managed Healthcare 
• All Plan Letters from the Department of Health Care Services
• Technical Assistance Guides with DHCS
• Technical Assistance Guides with DMHC
• List of Counties for the Models (COHS)
• Regulations for DMHC (Knox-Keene)
• Regulations for  DHCS
• Department of Insurance
• Medicare Managed Care Manual

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The following links are frequently used in our clinical reviews for Medicare and Medicare Advantage encounters:

• Centers for Medicare & Medicaid Services | CMS
• CMS Transmittals
• CMS Health Plans
• CMS Coding and Billing
• Medicare Coverage Determinations (MCDs) and National Coverage Determinations (NCDs)
• LCDs- Local Coverage Determinations

Medicare Manuals- Publications range from 01- 25, we frequent these 7:

• Medicare Manual- Publication # 100-01- Medicare General Information, Eligibility and Entitlement Manual
• Medicare Manual- Publication # 100-02-Medicare Benefit Policy Manual
• Medicare Manual – Publication # 100-03 Medicare National Coverage Determinations (NCD) Manual
• Medicare Manual – Publication #100-04 Medicare Claims Processing Manual
• Medicare Manual- Publication # 100-08- Medicare Program Integrity Manual
• Medicare Manual – Publication # 100-15 Medicaid Program Integrity Manual
• Medicare Manual Publication #100-16 – Medicare Managed Care Manual

Recent Federal Rules that will be discussed:

• CMS 4201-F
• Federal Register :: Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly
• Medicare Advantage Program: eCFR :: 42 CFR Part 422 — Medicare Advantage Program
• CMS -0057-F
  • Federal Register :: Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children’s Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program

Additional Links:

• Application Programming Interfaces (APIs) and Relevant Standards and Implementation Guides (IGs) | CMS
• Office of Inspector General (OIG)
• California Medicare Administrator Contractor (MAC)