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Instruction Details
Use '*' for all payers
Use '*' for all specialties
Use '*' for all states
Lower numbers have higher priority (default: 100)
Only active instructions are considered during evaluation
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Define when and how this instruction should be applied. Include criteria for evaluation and priority rules.
Critical instructions for emergency situations. This content will be prioritized during urgent cases.
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Preview
Match Criteria:
Medicare * *
Specificity Score: 4
Higher scores indicate more specific matches
Priority: 10
Status:Active
Instructions Preview:
# Medicare Coding Instructions

## General Guidelines
- Always verify patient eligibility before coding
- Use appropriate modifiers for Medicare claims
- Follow CMS guidelines for documentation requirements

## Common Rules
1. Modifier Usage: Use modifier -25 for significant, separately identifiable E&M services
2. Documentation: Ensure all services are properly documented in the medical record
3. Billing: Submit claims within 90 days of service date

## Special Considerations
- Telehealth services require specific modifiers
- Preventive services have different coding requirements
- Chronic care management has specific documentation needs
Evaluation Rules Preview:
# Medicare Evaluation Rules

## When to Apply This Rule
- Patient has Medicare as primary or secondary insurance
- Service is covered under Medicare guidelines
- Provider is enrolled with Medicare

## Evaluation Criteria
1. Insurance Verification: Confirm Medicare eligibility
2. Service Coverage: Verify service is covered under Medicare
3. Documentation: Ensure all required documentation is present
4. Modifier Requirements: Check if specific modifiers are needed

## Priority Application
- Apply this rule when no more specific Medicare rules exist
- Override with specialty-specific or state-specific Medicare rules when available
Help
Wildcard Usage:
  • * in any field means "all" for that criteria
  • More specific rules (fewer wildcards) take priority
  • Priority field breaks ties between equally specific rules
Examples:
  • Medicare, *, * - Applies to all Medicare cases
  • *, Dermatology, * - Applies to all dermatology cases
  • Medicare, Dermatology, California - Most specific rule