decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Medicare_Claims_Processing_Manual / Chapter_20 / 20-20
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Article Overview
This article covers Medicare payment-rate calculation and update processes within Chapter 20 of the Medicare Claims Processing Manual. It explains the general role of CMS in furnishing annual and special updates, how payment schedules are distributed to contractors and other entities, and how certain durable medical equipment, prosthetic, orthotic, and parenteral/enteral nutrition payment methodologies fit into the broader update framework. It is relevant to Medicare billing, reimbursement, and claims processing professionals who need a high-level understanding of how fee schedule amounts are maintained and communicated.
Why This Topic Matters
Accurate payment-rate updates affect claims processing, reimbursement timing, and coordination among Medicare contractors and related organizations. Understanding this section helps stakeholders recognize where updated amounts come from and how they are disseminated for payment of covered items and services.
Article Sections
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20 - Calculation and Update of Payment Rates
Overview of Medicare payment-rate calculation and update responsibilities. Discusses CMS distribution of updated fee schedule amounts and the involvement of contractors and related organizations.
What You Will Learn
- How CMS handles updates to Medicare payment schedules and national limitation amounts
- Which organizations receive fee schedule information and related updates
- How payment methodology changes are described at a high level for selected services
- How this manual section fits into Medicare claims processing operations
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Medicare claims processors
- DMEPOS suppliers
- Compliance professionals
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