Review mock Medicare & Medicaid claims against real coverage rules. Decide Approve, Deny, or Pend — and learn instantly when you miss.
National Coverage Determination basics for outpatient physician services.
Local Coverage Determination edits, medical necessity, and prior-auth rules.
Durable medical equipment and high-cost imaging coverage rules.
Inpatient hospital, skilled nursing facility, and the Two-Midnight & 3-day qualifying-stay rules.
Formulary tiers, prior authorization, step therapy, and statutorily excluded drug categories.
Mixed Part A and Part B scenarios spanning the full Original Medicare fee-for-service benefit.
Patient-Driven Groupings Model audits from OASIS forms. Spot upcoding and diagnosis mismatches before payment.
Made with Emergent