Addressing the Three Ms of the CMS Provider Compliance Program: Medicare, Medicare Advantage and Medical Necessity

Best practices to ensure compliance, prevent denials and deliver excellent patient care


The CMS provider compliance program includes multiple agencies, all tasked with ensuring the Medicare Trust Fund is spent properly. To guide providers, CMS produces National Coverage Determinations (NCDs), and the Medicare Administrative Contractors produce Local Coverage Determinations (LCDs). When no NCD or LCD exists, the standard of care prevails to determine medical necessity. In this webinar, the most common medical necessity denials will be reviewed with strategies for denial prevention, and new and future NCDs will be presented. In this webinar, you’ll also:


  • Briefly review the NCD and LCD development process
  • Discuss best practices to ensure compliance with NCDs and LCDs
  • Provide guidance for determining medical necessity in the absence of an NCD or LCD

Join us for this valuable session as our experts provide information that can help your organization achieve better compliance, improved reimbursement and superior care quality.



Ronald Hirsch, MD, FACP, CHCQM
Vice President of the Regulations and Education Group at R1 RCM


Janice Amon, CCDS, CCS
Corporate Compliance Audit & Clinical Manager at Sharp Healthcare


On-Demand Webinar