Help: FAQs, tutorials, videos, page index and more
Viewing:  Nov 20, 2019

Medicare Articles and Resources

 

Medicare Jurisdiction 15 - Links/Resources

Map

Medicare Jurisdiction N - Links/Resources

Map

Medicare Jurisdiction 6 - Links/Resources

Map

Medicare Jurisdiction K - Links/Resources

Map

Medicare Jurisdiction E - Links/Resources

Map

Medicare Jurisdiction F - Links/Resources

Map

Medicare Jurisdiction H - Links/Resources

Map

Medicare Jurisdiction L - Links/Resources

Map

Medicare Jurisdiction J - Links/Resources

Map

Medicare Jurisdiction M - Links/Resources

Map

Medicare Jurisdiction 5 - Links/Resources

Map

Medicare Jurisdiction 8 - Links/Resources

Map
 

General Links and Resources

CMS Noridian - Active LCDs

CMS Noridian - Active LCDs

Hospital Outpatient Regulations and Notices

Hospital Outpatient Regulations and Notices

Medicare Enrollment

PECOS- Medicare Provider Enrollment, Chain, and Ownership System

Medicare Provider/Supplier to Healthcare Provider Taxonomy

Medicare Provider/Supplier to Healthcare Provider Taxonomy

General Billing Requirements

Ch. 1 Medicare Claims Processing Manual

Find-A-Code Links and Resources

NCDs

National Coverage Determinations

Select the title to see a summary and a link to the full article.

Changes to Portable X-Ray Requirements

|

On September 30, 2019, CMS published a final rule which made changes to portable x-ray services requirements as found in the law.

Read the article →

CMS and HHS Tighten Enrollment Rules and Increase Penalties

|

This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019.  There have been known problems ...

Read the article →

Are You Aware of Medicare Advantage Plans Timely Filing Rules?

|

The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...

Read the article →

The OIG Work Plan: What Is It and Why Should I Care?

|

The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

Read the article →

The Slippery Slope For CDI Specialists

|

Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail.  Many of you in this industry are ...

Read the article →

Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?

|

Question: What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms. Answer: There is no question that these adjustments would be considered ...

Read the article →

Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain

|

Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.

Read the article →

Helping Others Understand How to Apply Incident to Guidelines

|

Over the past few months, I have worked with different organizations that have been misinterpreting the "incident to" guidelines and, in return, have been billing for services rendered by staff that are not qualified to perform the services per AMA and CPT. What I found within the variances is that ...

Read the article →

A United Approach

|

A United Approach As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...

Read the article →

Medicare Revises Their Appeals Process

|

On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place: The policy on use of electronic signatures Timing ...

Read the article →

What is Medical Necessity and How Does Documentation Support It?

|

We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

Read the article →

Q/A: What do I do When a Medicare Patient Refuses to Sign an ABN?

|

Question: What do I do when a Medicare patient refuses to sign an ABN? Answer: That depends on whether the patient is still demanding to have/receive the service/supply. If they aren’t demanding the service, then there is no need to force the issue. Just make sure that you still have an ...

Read the article →

Clearing Up Some Medicare Participation Misunderstandings

|

Even though we may think we truly understand what it means to be a participating provider, Medicare doesn’t quite work the way that other insurance plans do. Far too many providers do not understand the difference and get into hot water. To further complicate matters, the rules are different for ...

Read the article →

The Impact of Medical Necessity on High Level E/M Services

|

I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"  The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...

Read the article →

Revised ABN Requirements Still Fuzzy

|

Although it has been quite some time since ChiroCode published an article about the revised instructions for non-participating providers  who use the ABN, there are still some outstanding questions about this change. So far, Medicare has not provided additional guidance about this question despite requests by us for clarification. Medicare now requires non-participating providers to include the ...

Read the article →

Q/A: Can you Help me Understand the New Medicare Insurance Cards?

|

As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.

Read the article →

Understanding NCCI Edits

|

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...

Read the article →

Medicare Supplemental Policies (MediGap) and Extremity Adjustments

|

The nice thing about MediGap policies is that they pay for some of the healthcare costs that an original Medicare plan (Part B) does not cover. So when a patient has Medicare and a Medicare supplement (MediGap) and their condition is related to an extremity (a noncovered service), Medicare must ...

Read the article →

Coding Medicare Initial Preventive Physical Exams (IPPE)

|

The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward. Purpose An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...

Read the article →

Charging Missed Appointment Fees for Medicare Patients

|

Some providers mistakenly think that they cannot bill a missed appointment fee for Medicare beneficiaries. You can, but Medicare has specific rules that must be followed. These rules are outlined in the Medicare Claims Policy Manual, Chapter 1, Section 30.3.13. You must have an official “Missed Appointment Policy” which is ...

Read the article →

Attestations Teaching Physicians vs Split Shared Visits

|

Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...

Read the article →

Empowering Medicare Beneficiaries

|

BLOG: CMS announced a NEWS release today making it easier to help Medicare Beneficiaries access cost and quality information. CMS announced,  "Today, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to some of ...

Read the article →

How to Report Co-Surgeons Using Modifier 62

|

Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session. An easy way to explain this is to visualize a patient requiring cervical fusion where ...

Read the article →

Home Oxygen Therapy

|

Home Oxygen Therapy Guidelines

Read the article →

CMS Finalizes Major Changes to ACO Program

|

Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register ...

Read the article →

Medicare Advantage Providers are not Required to be Enrolled in Medicare

|

There was a ruling that was requiring providers to be enrolled in Medicare in order to provide services for Part C (Medicare Advantage (MA)) and/or Part D. However, on April 2, 2018, CMS released the 2019 Final Rules for MA and Part D which changed this previous ruling. According to ...

Read the article →

Errors Billing Outpatient Services When Patient is also Inpatient

|

The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals.  CMS suggests using the following resources to ensure compliance: Medicare Inappropriately Paid Acute-Care Hospitals for ...

Read the article →

Allergy Immunotherapy Coding Guidelines (CMS) Effective: 01/01/2006

|

Immunotherapy (Allergy Shots) is a medical treatment to used to treat and prevent reactions or desensitize the immune system to specific allergens that trigger allergy symptoms.  Payers have specific coverage guidance and rules for reporting injections, the specific type of antigen(s) provided and how they should be reported.  Below are the coding guidelines from ...

Read the article →

Reciprocal Billing and Locum Tenens Arrangements Changes

|

CMS has made changes to their payment policies for reciprocal billing arrangements and Fee-For-Time compensation arrangements (formerly referred to as locum tenens arrangements). Providers need to be aware of these changes and update their policies as appropriate.

Read the article →

Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?

|

The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...

Read the article →

CMS: Medicare Diabetes Prevention Program Expanded Model

|

CMS announces the Medicare Diabetes prevention program is now a new covered service. Per a recent MLN news release. Medicare Beneficiaries will be notified in 2019 in a Medicare handout. Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately...

Read the article →

Keys to Successful Claims Filing

|

There are many factors that can contribute to your success in filing claims and getting reimbursed.  The information below is from the CMS website. Completing Item 12, Patient's or Authorized Person's Signature, on the CMS-1500 form for a non-assigned claim A signature on file (SOF) indicates the supplier has obtained the beneficiary's one-time authorization on ...

Read the article →

PSAVE Pilot Program - What Does it Mean to You?

|

Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?

Read the article →

Medicare Timed Codes Guidelines

|

Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time. It should be noted that while ...

Read the article →

BREAKING NEWS: CMS Proposes to Change E&M Coding

|

On July 16th 2018, anyone subscribed to the CMS Quality Payment Program received an e-mail containing a letter to doctors from Seem Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS). There are some widespread changes proposed in this letter of which you need to be aware. Where ...

Read the article →

Q/A: Is it Legal to Shred Archived Patient Records After a Certain Amount of Time?

|

Shredding patient records. When is it appropriate? Read more to find out.

Read the article →

CMS Proposes Changes to Evaluation & Management Requirements

|

It is no secret that providers have long argued that E/M coding is burdensome and does not truly reflect the services provided. This fact is acknowledged by CMS with the following statement "Prior attempts to revise the E/M guidelines were unsuccessful or resulted in additional complexity due to lack of ...

Read the article →

Provider-Based Facilities and Split Billing: Is Your Facility Being Reimbursed for All Work Performed?

|

Are you stumped by billing guidelines for provider-based facilities? Who bills for what and why? Read on to hear how a little extra time and effort spent on researching split billing coding guidelines can greatly impact your facility, and even your budget ensuring reimbursement for all services performed.   For ...

Read the article →

Dual Medicare-Medicaid Billing Problems

|

It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...

Read the article →

ESRD Claims Error: Transitional Drug Adjustment Add-On Payment Adjustment

|

Medicare sent out a news release to inform of incorrect reimbursement and correction. "End Stage Renal Disease (ESRD) claims are incorrectly reimbursed if they: Are eligible for Transitional Drug Adjustment Add-On Payment Adjustment and Contain non-covered charges After we fix the system on January 1, 2019, your Medicare Administrative Contractor will mass adjust claims ...

Read the article →

Q/A: Do I Have a Patient with Part C sign an ABN if we are Out-of-Network?

|

Do we need an ABN if the patient has Part C and we are out-of-network? Read More.

Read the article →

Medicare Claim Submission Exceptions

|

There are several exceptions to the Medicare "Mandatory Claim Submission Rule." What are they?

Read the article →

Q/A: Can a PT Assistant Perform Physical Therapy Modalities?

|

Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.

Read the article →

Home Oxygen Therapy -- CMN for Oxygen

|

The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.

Read the article →

Will Medicare's Proposed Reformations Affect Your Practice?

|

Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards more value based payment systems, innovation and new models are being sought to both reduce costs and increase quality. This article outlines the ideas presented in the ...

Read the article →

Q/A: Am I Supposed to List the Frequency and Duration on the ABN?

|

How to fill out Box D (Services) on the ABN form. What information is required?

Read the article →

Documenting DMEs

|

As per MLN MM8304,  This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g). Due to concerns ...

Read the article →

Indications for Serotypes A and B Botulinum Toxins

|

According to Novitas LCD L27476, the following indications apply: 1. Blepharospasm and strabismus2. Spastic dystonia or focal dystonias to relieve pain, to assist posturing and walking, to increase range of motion, to assist in the outcome of physical therapy, and/or to reduce spasm thus allowing adequate perineal hygiene.3. Spasmodic dysphonia4. Achalasia and cardiospasm when ...

Read the article →

Q/A: With a Maintenance Patient of Medicare age that has a Medicare Replacement Plan (Part C), do They Need to Fill out an ABN?

|

Q/A: With a maintenance patient of medicare age that has a medicare replacement plan (Part C), do they need to fill out an ABN?

Read the article →

Medicare Using Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting January 2018

|

On June 17, 2016, CMS announced the release of its final rule implementing section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA). This final rule requires reporting entities to report private payor rates paid to laboratories for lab tests, which will be used to calculate Medicare payment ...

Read the article →

OIG Reviews Medicare Advantage Claims

|

On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that: "Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; ...

Read the article →

Psychiatric Partial Hospitalization Programs

|

Psychiatric Partial Hospitalization Programs (PHPs) are a more comprehensive level of care than Intensive Outpatient Programs (IOPs - click here to read more about IOPs). When the patient requires a minimum of 20 hours per week and hospitalization is not clinically indicated, a PHP can be the most effective type of ...

Read the article →

NEW on Find-A-Code...National Coverage Determinations (NCDs)

|

Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...

Read the article →

Medicare Requiring Specific Modifiers on Therapy Services

|

Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following: Services furnished under the Outpatient ...

Read the article →

Billing with a GP Modifier

|

Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?

Read the article →

Quality Payment Program in 2018

|

I checked the government website to see if I am an eligible clinician and it says that I am not. I just don't want to get blindsided with a letter saying I will be penalized. Is there anything you would suggest or recommend that I do now to protect myself from future penalties. Thank you

Read the article →

Show older articles ↓


There are more articles. View all articles...

View articles for the current organization by subtopic:



Access to this feature is available in the following products:
  • HCC Coder
  • Find-A-Code Professional
  • Find-A-Code Facility Base


Select the webinar title to view a summary and link to the webinar video.

November 5, 2019: Proving Medical Necessity and Functional Improvement

Topic and description coming soon!

Watch the video →

September 10, 2019 — Inappropriate Payments Made to Chiropractors – An OIG Review

In this webinar, Dr. Gwilliam will take you on a fun filled journey through all of the reports created by the Office of the Inspector General based on their reviews of chiropractors. If you can understand what they see, and what advice they give Medicare when dealing with chiropractors, then you will be better prepared to not become their next target. This webinar may feel a little frightening with hundreds of thousands of dollars paid back to CMS, but, by the end, you will know exactly what to do and what not to do.

Watch the video →

July 9th, 2019: Expanding Chiropractic Coverage in Medicare

Presented by Ron Short DC, MCS-P, CPC July 9th, 2019 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Register here: https://register.gotowebinar.com/register/2199887868052877059 ...

Watch the video →

Chiropractic Manipulative Treatment and Medicare - Part 2

In this CE webinar, Dr. Gwilliam will continue his discussion from the webinar delivered Dec. 18 about chiropractic manipulative treatment. But this time, it is all about Medicare. If you don't treat Medicare beneficiaries, you should probably listen anyway. Usually whatever Medicare wants is the same thing as all the other payers. Find out the difference between acute, chronic, and maintenance, as well as when to use certain modifiers.

Watch the video →

Medicare Reviews

Medicare continues to increase their efforts to review doctors and recover “overpayments”. This increases the likelihood that your notes will be reviewed and that you will be required to pay money back to Medicare. In this webinar Dr. Short will show you:  Why you should appeal every adverse decision.  How to appeal adverse decisions.  What information you need in your documentation for an effective appeal.  How to structure your appeals to be most effective.

Watch the video →

How to Create a Medicare Compliance Plan

In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to create an OIG/Medicare compliance plan. He will explain how to create policies, how to perform a "self-test" on your SOAP notes, search the Medicare exclusions list, Stark, anti-kickback and how to handle compliance concerns.

Watch the video →

Medicare Reviews

Medicare reviews claims for a variety of reasons. Some are routine and are not a problem for the doctor or the practice. Some are investigatory in nature and indicate a serious potential threat for both the doctor and the practice. Dr. Ron Short will go over the types of reviews and which are routine and which should cause you to lose sleep. In this webinar you will learn: -What routine reviews are and why they are conducted -What reviews are a potential risk -What triggers reviews -When to get help and what kind of help to get

Watch the video →

Coding and Auditing Wound Care

In this webinar, Aimee will review wound care coding and auditing information for wound care services, including proper modifier use, NCCI edits, Medicare coverage guidelines, and documentation requirements.

Watch the video →

Risky Business

This presentation will review how risk management is no longer limited to just malpractice claims. It also includes your financial policy. There is now a greater risk of financial loss due to improper discounting and faulty financial and collection policies than ever before. It is widely known that the Office of Inspector General (OIG) and Medicare are cracking down on healthcare fraud and abuse, but what most chiropractors are unaware of, is how widely successful these efforts have been. In this presentation, we will identify the five most dangerous things we face in chiropractic and how to avoid them. All attendees will receive a free sample 1-page financial policy that can be customized for their practice and a link to receive a free risk assessment score for their practice.

Watch the video →

The ABN 2018

The Advanced Beneficiary Notice of Non-coverage is one of the most important Medicare forms that you can use in your office because it protects your right to be paid. Dr. Ron Short will show you how, when and why to use the ABN and how to properly complete the form.

Watch the video →

What is RBRVS and How Can It Benefit Your Organization

What is RBRVS and How Can It Benefit Your Organization

Watch the video →

Show older webinars ↓


There are more webinars. View all webinars...

View webinars for the current organization by subtopic:


"Incident To" Services article by CMS1995 E/M Guidelines1997 E/M GuidelinesAccountable Care Organizations (ACO) - by CMSAdvanced Beneficiary Notice of Noncoverage (ABN) Form Instructions ToolBreach Notification Rule by HHSCare Plan Oversight (CPO) services information by CGS MedicareChiroCode Online Fee CalculatorCMS Complying with Medicare Signature Requirements Fact SheetCMS Innovation home pageCMS Physician Fee Schedule Look-UpCMS Recovery Audit Program - Center for Medicare & Medicaid ServicesCMS Report: "CMS Should Use Targted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic ServicesCMS/Medicare Podiatry ServicesCMS: Value Based Modifier (VBM)Continued Use of Modifier 59 after Jan 1, 2015Details about EHR Incentive ProgramDurable Medical Equipment (DME) Medicare Administrative Contractor (MAC) JurisdictionsDurable Medical Equipment Center (DME) - by CMSeHealth Initiative websiteEHR Topics PageElectronic Prescribing (eRx) Incentive Program - by CMSExclusion ListFAQ on the use of the AT and GA modifiers togetherFAQ_CodingFeedback Report Requests PortalFurther Details on the Revalidation of Provider Enrollment Information by CMSHCC Risk Calculator by Find-A-CodeHIPAA Risk Analysis and Risk Management Tip Sheet by OCRHIPAA: Health Insurance Portability and Accountability Act by AMAHospice - Medicare Claims Processing ManualHospice Quality Reporting DataHow to use the Medicare National Correct Coding Initiative (NCCI) Tools by MLNInappropriate Medicare Payments for Chiropractic Services Report - by the OIGInstaCode Online Fee CalculatorIs your Office Listed on the PECOS Listing?kidneyfund.org Anemia In Chronic Kidney Disease InformationLink to CMS Form - Request For Medicare Hearing by an Administrative Law JudgeLink to CMS Form - Request for Review of Administrative Law Judge (ALJ) Medicare Decision/DismissalLink to CMS Form - Third Level of Appeal: Hearing by an Administrative Law Judge FormsLink to CMS Form - Transfer of Appeal RightsMaintenance of Certification Program (MOC)Marketing to Medicare Beneficiaries - by MedicareMeasure-Applicability Validation (MAV) CourseMeasuring ImagesMedicare Advantage Plans: Cost Sharing LimitsMedicare and Medicaid Programs; Modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and Other Changes to the EHR Incentive Program; and Health InformatMedicare Appeals - by CMSMedicare Appeals ChangesMedicare as Secondary PayerMedicare Benefit Policy Manual, Chapter 15 (also known as Medicare Carriers Manual)Medicare Claims Processing Manual - Chapter 25Medicare Claims Processing Manual, Chapter 12Medicare Claims Processing Manual, Chapter 29 - Appeals of Claims DecisionsMedicare Claims Processing Manual, Chapter 9 - Rural Health Clinics/Federally Qualified Health CentersMedicare Compliance Manual 2018Medicare Coverage for Skilled NursingMedicare Electronic Claims Exemption - by CMSMedicare Medical Savings Account (MSA) Plans - by CMSMedicare Part A for Skilled NursingMedicare Prospective Payment System — General InformationMedicare Provider Enrollment Application InformationMedicare Provider-Supplier Enrollment - by CMSMedicare Reconsideration RequestMedicare Recovery Audit by HHS Office of the Inspector GeneralMedicare Redetermination RequestMedicare Removes SSN from Medicare Cards - Press ReleaseMedicare Secondary Payer fact sheet by CMSMedicare Shared Savings Program (MSSP) Requiremenst for ACOs - by ACAMedicare Specialities-Chapter 26Medicare Topics PageMedicare Topics Page - ChiropracticMedicare, Overpayments, FraudMedicare: To Participate or Not to Participate?Misinformation about Chiropractic Services - by Medicare Learning NetworkMLN ConnectsMLN Matters: Cataract Removal with Medicare Part BMLN Matters: MPPR on the TC of Diagnostic Cardiovascular and Ophthalmology ProceduresMLN Matters: Presbyopia-Correcting Intraocular LensesMLN: Medicare Vision Services Fact SheetNational Supplier Clearinghouse home pageNCCI Instructions for Modifier 59NPI RegistryNPRM Quality Payment Program Fact SheetOffice of Inspector General: Questionable Billing for Medicare Ophthalmology Services 2012Office of Inspector General: Questionable Billing for Medicare Ophthalmology Services 2015Opting out of Medicare and/or Electing to Order and Refer Services - MedLearn articleParticipating vs. Non-Participating (Medicare Part B Claims)Physician Quality Reporting System (PQRS) List of Eligible Professionals (EP) by CMSPoint of Origin for Admission or Visit Code (Formerly Source of Admission Code) for Inpatient Psychiatric Facilities (IPFs)PQRS FAQs - by the American Chiropractic AssociationPress release: New CMS rule allows flexibility in certified EHR technology for 2014Provider Payment Dispute Resolution for Non-Contracted Providers - by CMSQ&A on Skilled Nursing Facility Consolidated BillingQuality Payment ProgramReminder to Stop Billing Duplicate Claims by Medicare Learning NetworkSkilled Nursing Facility Best Practice GuidelinesSkilled Nursing Facility Consolidated BillingSkilled Nursing Facility Education and TrainingSpecial Advisory Bulletin, Offering Gifts and Other Inducements (2002) - by the Office of the Inspector General (OIG)Special Advisory Opinion 12-21 , Offering Gifts and Other Inducements (2013)- by the Office of the Inspector General (OIG)Summary of 2015 Physician Value-based Payment Modifier PoliciesTelehealth Psychiatric ServiceThe CMS eHealth InitiativeThe Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1 BUpdated Mobile Applications (Apps) for Open PaymentsWPS Medicare how do they price Non-ASP New drugs and NOC Drugs?Write Off InstructionsYour Guide to Who Pays First - by CMS

General Medical Resources

  • April 30, 2015 - "Physicians and Non-Physician Practitioners Reported on Part A Critical Access Hospital (CAH) Claims" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1505, "Physicians and Non-Physician Practitioners Reported on Part A Critical Access Hospital (CAH) Claims" has been released and is now available in downloadable format. This article is designed to provide education on the requirements set for submitting CAH Methods II claims. It also includes background information.
  • April 30, 2015 - "Accreditation for Ventilators" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1513, "Accreditation for Ventilators" has been released and is now available in downloadable format. This article is designed to provide education on accreditation requirements for ventilators to ensure that frequent and substantial servicing is provided to Medicare beneficiaries. It includes background information and key points.
  • April 30, 2015 - "The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Repairs and Replacements" Fact Sheet - Revised - "The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Repairs and Replacements" Fact Sheet (ICN 905283) was revised and is now available in downloadable format. This fact sheet is designed to provide education on repairs and replacements under the Medicare DMEPOS competitive bidding program. It includes information on which items and services can be provided by contract versus non-contract suppliers.
  • April 23, 2015 - "Vaccine and Vaccine Administration Payments under Medicare Part D" Fact Sheet - Revised - The "Vaccine and Vaccine Administration Payments under Medicare Part D" Fact Sheet (ICN 908764) was revised and is now available in downloadable format. This fact sheet is designed to provide education on vaccine payments under Medicare Part D. It includes information on the difference between Part B and Part D vaccine coverage, what Part D covers, and additional information on vaccine coverage under Part D plans.
  • April 23, 2015 - "Home Health Prospective Payment System" Fact Sheet - Revised - The "Home Health Prospective Payment System" Fact Sheet (ICN 006816) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Home Health Prospective Payment System (HH PPS). It includes the following information: background, consolidated billing requirements, criteria that must be met to qualify for home health services, therapy services, elements of the HH PPS, updates to the HH PPS, billing and payment for home health services, and Home Health Quality Reporting Program.
  • April 9, 2015 - "Food and Drug Administration Approval of First Biosimilar Product" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1509, "Food and Drug Administration Approval of First Biosimilar Product" has been released and is now available in downloadable format. This article is designed to provide education on CMS policies regarding FDA approved new product. It includes questions and answers for biosimilar products.
  • April 9, 2015 - "Discontinued Coverage of Vacuum Erection Systems (VES) Prosthetic Devices in Accordance with the Achieving a Better Life Experience Act of 2014" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1511, "Discontinued Coverage of Vacuum Erection Systems (VES) Prosthetic Devices in Accordance with the Achieving a Better Life Experience Act of 2014" has been released and is now available in downloadable format. This article is designed to provide education on the changes made to the July Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule related to VES devices and prohibits payment on claims for VES prosthetic devices for dates of service on or after July 1, 2015. It includes background information.
  • April 9, 2015 - "Partial Hospitalization Program (PHP) Claims Coding & CY2015 per Diem Payment Rates" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1512, "Partial Hospitalization Program (PHP) Claims Coding & CY2015 per Diem Payment Rates" has been released and is now available in downloadable format. This article is designed to provide education on the issuance of the CY 2015 final corrected per diem payment rates for PHP services. It includes background information with tables.
  • April 9, 2015 - "Medicare Information for Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants" Booklet - Revised - The "Medicare Information for Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants" Booklet (ICN 901623) was revised and is now available in downloadable format. This booklet is designed to provide education on Medicare services furnished by certified registered nurse anesthetists, anesthesiologist assistants, nurse practitioners, certified nurse-midwives, clinical nurse specialists, and physician assistants. It includes the required qualifications, coverage criteria, billing, and payment for these provider types.
  • April 9, 2015 - "The ABCs of the Initial Preventive Physical Examination (IPPE)" Educational Tool - Revised - "The ABCs of the Initial Preventive Physical Examination (IPPE)" Educational Tool (ICN 006904) was revised and is now available in downloadable format. This educational tool is designed to provide education on IPPE. It includes a list of elements that must be included in the IPPE, as well as coverage and coding information.
  • April 9, 2015 - "The ABCs of the Annual Wellness Visit (AWV)" Educational Tool - Revised - "The ABCs of the Annual Wellness Visit (AWV)" Educational Tool (ICN 905706) was revised and is now available in downloadable format. This educational tool is designed to provide education on the AWV. It includes a list of the required elements in the initial and subsequent AWVs, as well as coverage and coding information.
  • April 2, 2015 - "Preventive Services" Educational Tool - Revised - The "Preventive Services" Educational Tool (ICN 006559) was revised and is now available in an interactive format. This educational tool is designed to provide education on Medicare-covered preventive services. It includes coverage, coding, and payment information.
  • April 2, 2015 - "Long Term Care Hospital Prospective Payment System" Fact Sheet - Revised - The "Long Term Care Hospital Prospective Payment System" Fact Sheet (ICN 006956) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Long Term Care Hospital (LTCH) Prospective Payment System. It includes the following information: LTCH certification, Medicare Severity Long Term Care Diagnosis-Related Groups patient classification, payment policy adjustments, payment updates, and LTCH Quality Reporting Program.
  • April 2, 2015 - "Clinical Laboratory Fee Schedule" Fact Sheet - Revised - The "Clinical Laboratory Fee Schedule" Fact Sheet (ICN 006818) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Clinical Laboratory Fee Schedule (CLFS). It includes the following information: background, coverage of clinical laboratory services, how payment rates are set, and updates to the CLFS.
  • April 2, 2015 - "Medicare Appeals Process" Fact Sheet - Reminder - The "Medicare Appeals Process" Fact Sheet (ICN 006562) is available in downloadable format. This fact sheet is designed to provide education on the five levels of claim appeals in Original Medicare (Medicare Part A and Part B). It includes details explaining how the Medicare appeals process applies to providers, participating physicians, and participating suppliers in addition to including information on available appeals-related resources.
  • April 2, 2015 - "Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians" Fact Sheet - Reminder - The "Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians" Fact Sheet (ICN 905645) is available in downloadable format. This fact sheet is designed to provide education for physicians on understanding how to comply with Federal laws that combat fraud and abuse and ensure appropriate quality medical care. It includes information on identifying "red flags" that could lead to potential liability in law enforcement and administrative actions.
  • March 12, 2015 - "Guidance on the Physician Quality Reporting System (PQRS) 2013 Reporting Year and 2015 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1508, "Guidance on the Physician Quality Reporting System (PQRS) 2013 Reporting Year and 2015 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs)," has been released and is now available in downloadable format. This article is designed to provide education on the PQRS 2013 reporting year and 2015 payment adjustment for RHCs, FQHCs, and CAHs.
  • March 12, 2015 - "Global Surgery" Fact Sheet - Revised - The "Global Surgery" Fact Sheet (ICN 907166) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the components of a global surgery package. It includes information about billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians.
  • March 12, 2015 - "Guidelines for Teaching Physicians, Interns, and Residents" Fact Sheet - Revised - The "Guidelines for Teaching Physicians, Interns, and Residents" Fact Sheet (ICN 006347) was revised and is now available in downloadable format. This fact sheet is designed to provide education on physician services in teaching settings. It includes information on payment for physician services in teaching settings, general documentation guidelines, evaluation and management (E/M) documentation guidelines, and exception for E/M services furnished in certain primary care centers. It also includes resources and a glossary.
  • March 12, 2015 - "Mental Health Services" Booklet - Revised - The "Mental Health Services" Booklet (ICN 903195) was revised and is now available in downloadable format. This booklet is designed to provide education on mental health services. It includes the following information: covered and non-covered mental health services, eligible professionals, supplier charts, assignment, outpatient and inpatient psychiatric hospital services, same day billing guidelines, and National Correct Coding Initiative.
  • March 12, 2015 - "Medicare Vision Services" Fact Sheet - Reminder - The "Medicare Vision Services" Fact Sheet (ICN 907165) is available in a downloadable format. This fact sheet is designed to provide education on Medicare coverage and billing information for vision services. It includes specific information concerning coding requirements and an overview of coverage guidelines and exclusions.
  • March 12, 2015 - "HIPAA Privacy and Security Basics for Providers" Fact Sheet - Reminder - The "HIPAA Privacy and Security Basics for Providers" Fact Sheet (ICN 909001) is available in a downloadable format. This fact sheet is designed to provide education on basic HIPAA privacy and basic HIPAA security information for providers. It includes information on covered entities, business associates, and the disposal of private health information.
  • March 5, 2015 - "Physician Feedback, Quality and Resource Use Reports (QRURs) and Value-Based Modifier Program – Overview & Implementation" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1507, "Physician Feedback, Quality and Resource Use Reports (QRURs) and Value-Based Modifier Program – Overview & Implementation" has been released and is now available in downloadable format. This article is designed to provide education on the Physician Feedback/Value-Based Payment Modifier Program that will provide comparative performance information to individual physicians and groups, as part of Medicare's efforts to improve the quality and efficiency of medical care.
  • March 5, 2015 - "Diagnosis Coding: Using the ICD-10-CM" Web-Based Training Course - Released - The "Diagnosis Coding: Using the ICD-10-CM" Web-Based Training Course (WBT) was released and is now available. This WBT is designed to provide education on the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). It includes ICD-10-CM/PCS implementation guidance, information on the new ICD-10-CM classification system, and coding examples. Continuing education credits are available to learners who successfully complete this course. See course description for more information. To access the WBT, go to Medicare Learning Network® Products (use the link above), scroll to "Related Links" at the bottom of the web page, and click on "Web-Based Training Courses."
  • March 5, 2015 - "Medicare Physician Fee Schedule" Fact Sheet - Revised - The "Medicare Physician Fee Schedule" Fact Sheet (ICN 006814) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Medicare Physician Fee Schedule (PFS). It includes the following information: physician services, Medicare PFS payment rates, and resources.
  • March 5, 2015 - "Medicare Enrollment Guidelines for Ordering/Referring Providers" Fact Sheet - Reminder - The "Medicare Enrollment Guidelines for Ordering/Referring Providers" Fact Sheet (ICN 906223) is available in downloadable format. This fact sheet is designed to provide education on the Medicare enrollment requirements for eligible ordering/referring providers. It includes information on the three basic requirements for ordering and referring, and who may order and refer for Medicare Part A Home Health Agency, Part B, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) beneficiary services.
  • March 5, 2015 - "Medicare Fraud & Abuse: Prevention, Detection, and Reporting" Fact Sheet - Reminder - The "Medicare Fraud & Abuse: Prevention, Detection, and Reporting" Fact Sheet (ICN 006827) is available in downloadable format. This fact sheet is designed to provide education on preventing, detecting, and reporting Medicare fraud and abuse. It includes fraud and abuse definitions, as well as an overview of the laws used to fight fraud and abuse; descriptions of the government partnerships engaged in preventing, detecting, and fighting fraud and abuse; and resources on how providers can report suspected fraud and abuse.
  • February 26, 2015 - "Medicare Basics Commonly Used Acronyms" Educational Tool - Released - The "Medicare Basics Commonly Used Acronyms" Educational Tool (ICN 908999) was released and is now available in downloadable format. This interactive educational tool is designed to give you a list of acronyms you commonly see in Medicare publications. It includes a clickable list of alphabetized acronyms, with additional definitions and information on certain acronyms.
  • February 26, 2015 - "Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492" MLN Matters® Article - Revised - MLN Matters® Article #SE1408, "Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492" was revised and is now available in downloadable format. This article is designed to provide education on the required use of the ICD-10 code sets for dates of service on and after October 1, 2015. It includes tables for providers regarding claims that span the periods where ICD-9 and ICD-10 codes may both be applicable. This article updates MLN Matters® Article #MM7492 to reflect the October 1, 2015, implementation date. This article was revised to add a question and answer at the bottom of page 2 regarding dual processing of ICD-9 and ICD-10 codes.
  • February 19, 2015 - "Independent Diagnostic Testing Facility (IDTF)" Fact Sheet - Released - "Independent Diagnostic Testing Facility (IDTF)" Fact Sheet (ICN 909060) was released and is now available in downloadable format. This fact sheet is designed to provide education on requirements for the IDTF. It includes information on enrollment; the effective date of billing privileges; billing issues; ordering of tests; place of service issues; and requirements for multi-state IDTFs, physicians, and technicians.
  • February 19, 2015 - "Chronic Care Management Services" Fact Sheet - Released - "Chronic Care Management Services" Fact Sheet (ICN 909188) was released and is now available in downloadable format. This fact sheet is designed to provide background on the separately payable Chronic Care Management (CCM) services for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions. It includes information on eligible providers and patients, Physician Fee Schedule billing requirements, and a table aligning the CCM Scope of Service Elements and billing requirements with the Certified Electronic Health Record or other electronic technology requirements.
  • February 19, 2015 - "Provider Compliance Tips for Spinal Orthoses" Fact Sheet - Released - "Provider Compliance Tips for Spinal Orthoses" Fact Sheet (ICN 909187) was released and is now available in downloadable format. This fact sheet is designed to provide education on spinal orthoses. It includes helpful tips on how to prevent claim denials, as well as documentation needed to submit a claim for spinal orthoses.
  • February 19, 2015 - "Provider Compliance Tips for Enteral Nutrition Pumps" Fact Sheet - Released - "Provider Compliance Tips for Enteral Nutrition Pumps" Fact Sheet (ICN 909186) was released and is now available in downloadable format. This fact sheet is designed to provide education on enteral nutrition pumps. It includes helpful tips on how to prevent claim denials, as well as documentation needed to submit a claim for enteral nutrition pumps.
  • February 19, 2015 - "Provider Compliance Tips for Diabetic Test Strips" Fact Sheet - Released - "Provider Compliance Tips for Diabetic Test Strips" Fact Sheet (ICN 909185) was released and is now available in downloadable format. This fact sheet is designed to provide education on diabetic test strips. It includes helpful tips on how to prevent claim denials, as well as documentation needed to submit a claim for diabetic testing supplies.
  • February 12, 2015 - "Hospital Outpatient Prospective Payment System" Fact Sheet - Revised - Released - The "Hospital Outpatient Prospective Payment System" Fact Sheet (ICN 006820) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Hospital Outpatient Prospective Payment System. It includes the following information: background, ambulatory payment classifications, how payment rates are set, payment rates, and Hospital Outpatient Quality Reporting Program.
  • February 12, 2015 - "DMEPOS Quality Standards" Booklet - Reminder - Released - The "DMEPOS Quality Standards" Booklet (ICN 905709) is available in downloadable format. This booklet is designed to provide education on Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). It includes DMEPOS quality standards as well as information on Medicare deemed Accreditation Organizations (AOs) for DMEPOS suppliers.
  • February 12, 2015 - "Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Information for Pharmacies" Fact Sheet - Reminder - Released - The "Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Information for Pharmacies" Fact Sheet (ICN 905711) is available in downloadable format. This fact sheet is designed to provide education for pharmacies on DMEPOS. It includes information on accreditation by a CMS-approved independent national Accreditation Organization (AO) as well as information if a pharmacy wants to be considered for an exemption from the accreditation requirements.
  • February 12, 2015 - "Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services" Fact Sheet - Reminder - Released - The "Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services" Fact Sheet (ICN 904084) is available in downloadable format. This fact sheet is designed to provide education on SBIRT services. It includes an early intervention approach that targets those with nondependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment.
  • February 5, 2015 - "Payment Codes on Home Health Claims Will Be Matched Against Patient Assessments" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1504, "Payment Codes on Home Health Claims Will Be Matched Against Patient Assessments" was released and is now available in downloadable format. This article is designed to provide education on a system change that will compare the Health Insurance Prospective Payment System (HIPPS) code on a Medicare home health claim to the HIPPS code generated by the corresponding Outcomes and Assessment Information Set (OASIS) assessment before the claim is paid. It includes information on how this change will be implemented and how it will impact home health agencies.
  • February 5, 2015 - "Extension of Provider Enrollment Moratoria for Home Health Agencies and Part B Ambulance Suppliers" MLN Matters® Article - Revised - MLN Matters® Special Edition Article #SE1425, "Extension of Provider Enrollment Moratoria for Home Health Agencies and Part B Ambulance Suppliers" was revised and is now available in downloadable format. This article is designed to provide education on the extension of the temporary moratoria for an additional 6 months in certain geographic locations. It includes background information and tables. This article was revised to reflect an extension of the moratoria for an additional 6 months.
  • January 29, 2015 - "Continued Use of Modifier 59 after January 1, 2015" MLN Matters® Article - Released - MLN Matters® Article #SE1503, "Continued Use of Modifier 59 after January 1, 2015" was released and is now available in downloadable format. This article is designed to provide education on continued use of the new –X {EPSU} modifiers, as outlined in Change Request 8863. It includes information to remind providers that they may continue using the -59 modifier after January 1, 2015, in any instance in which it was correctly used prior to January 1, 2015.
  • January 29, 2015 - "Telehealth Services" Fact Sheet - Revised - The "Telehealth Services" Fact Sheet (ICN 901705) was revised and is now available in downloadable format. This fact sheet is designed to provide education on services furnished to eligible Medicare beneficiaries via a telecommunications system. It includes information about originating sites, distant site practitioners, telehealth services, billing and payment for professional services furnished via telehealth, billing and payment for the originating site facility fee, resources, and lists of helpful websites and Regional Office Rural Health Coordinators.
  • January 29, 2015 - "Medicare Part B Immunization Billing" Educational Tool - Revised - The "Medicare Part B Immunization Billing" Educational Tool (ICN 006799) has been revised and is now available in downloadable format. This educational tool is designed to provide education on Medicare-covered preventive immunizations. It includes coverage, coding, and billing information on the influenza, pneumococcal, and Hepatitis B vaccines and their administration.
  • January 22, 2015 - "Opting out of Medicare and/or Electing to Order and Certify Items and Services to Medicare Beneficiaries" MLN Matters® Article - Revised - MLN Matters® Special Edition Article #SE1311, "Opting out of Medicare and/or Electing to Order and Certify Items and Services to Medicare Beneficiaries" was revised and is now available in downloadable format. This article is designed to provide education on the necessity to file an affidavit with Medicare to opt-out of Medicare. It also clarifies the difference between providers who are permitted to opt-out and providers who opt-out and elect to order and refer services. This article was revised to add clarifying language on the opt-out process and requirements, especially with regard to the definition of "opt-out."
  • January 15, 2015 - "Ambulance Fee Schedule" Fact Sheet - Revised - The "Ambulance Fee Schedule" Fact Sheet (ICN 006835) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Ambulance Fee Schedule. It includes the following information: background, the Medicare ambulance transport benefit, ambulance providers and suppliers, Advance Beneficiary Notice of Noncoverage, payments, how payment rates are set, and updates to the fee schedule.
  • January 15, 2015 - "Medicare Secondary Payer for Providers, Physicians, Other Suppliers, and Billing Staff" Fact Sheet - Revised The "Medicare Secondary Payer for Providers, Physicians, Other Suppliers, and Billing Staff" Fact Sheet (ICN 006903) was revised and is now available in a downloadable format. This fact sheet is designed to provide education on the Medicare Secondary Payer (MSP) provisions. It includes information on MSP basics, common situations when Medicare may pay first or second, Medicare conditional payments, the Coordination of Benefits rules, and role the Benefits Coordination & Recovery Center.
  • January 8, 2015 - "Certifying Patients for the Medicare Home Health Benefit" MLN Matters® Article - Released - MLN Matters® Article #SE1436, "Certifying Patients for the Medicare Home Health Benefit" was released and is now available in downloadable format. This article is designed to provide education on the Medicare home health services benefit, including patient eligibility requirements and certification/recertification requirements of covered Medicare home health services. It includes an overview of the Medicare home health services benefits and a list of eligibility and certification requirements.
  • January 8, 2015 - "Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations" MLN Matters® Article - Released - MLN Matters® Article #MM9051, "Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations" was released and is now available in downloadable format. This article is designed to provide education on updates to the Medicare pneumococcal vaccine coverage requirements, as outlined in Change Request 9051. It includes information on new Advisory Committee on Immunization Practices (ACIP) recommendations for administering two different pneumococcal vaccinations.
  • January 8, 2015 - "Discharge Planning" Booklet - Revised - The "Discharge Planning" Booklet (ICN 908184) was revised and is now available in downloadable format. This booklet is designed to provide education on Medicare discharge planning. It includes discharge planning information for Acute Care Hospitals, Inpatient Rehabilitation Facilities, and Long Term Care Hospitals; Home Health Agencies; Hospices; Inpatient Psychiatric Facilities; Long Term Care Facilities; and Swing Beds.
  • January 8, 2015 - "The Basics of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation" Fact Sheet - Reminder - "The Basics of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation" Fact Sheet (ICN 905710) is available in downloadable format. This fact sheet is designed to provide education on DMEPOS. It includes information so suppliers can meet DMEPOS quality standards established by CMS and become accredited by a CMS-approved independent national Accreditation Organization (AO). There is also information on the types of providers who are exempt.
  • December 18, 2014 - "Medical Privacy of Protected Health Information" Fact Sheet - Revised - The "Medical Privacy of Protected Health Information" Fact Sheet (ICN 006942) was revised and is now available in a downloadable format with a print ready feature. This fact sheet is designed to provide education on resources and information regarding the HIPAA Privacy Rule and how this rule applies to customary health care practices. It includes information on accessing the HHS HIPAA web page resources.
  • December 11, 2014 - The "Skilled Nursing Facility Prospective Payment System" Fact Sheet - (ICN 006821) is designed to provide education on the Skilled Nursing Facility Prospective Payment System (SNF PPS). It includes information on the background and elements of the SNF PPS.
  • December 11, 2014 - "Inpatient Rehabilitation Facility Prospective Payment System" Fact SheetM - (ICN 006847) is designed to provide education on the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). It includes the following information: background, elements of the IRF PPS, payment updates, and IRF Quality Reporting Program.
  • December 11, 2014 - "Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs" MLN Matters® Article - Revised - MLN Matters® Special Edition Article #SE1434, "Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs" was revised and is now available in a downloadable format. This article is designed to provide education on writing prescriptions for Medicare beneficiaries for Medicare Part D drugs. It includes background information and examples. The article was revised to emphasize that form CMS-855O is appropriate for use by prescribers.
  • December 11, 2014 - "Skilled Nursing Facility Billing Reference" Fact Sheet - Revised - "Skilled Nursing Facility (SNF) Billing Reference" Fact Sheet (ICN 006846) was revised and is now available in downloadable format. This fact sheet is designed to provide education on Medicare Part A which covers skilled nursing and rehabilitation care in a SNF under certain conditions for a limited time. It includes information for SNF providers about SNF coverage, SNF payment, and SNF billing.
  • December 11, 2014 - "The Basics of Internet-based PECOS for DMEPOS Suppliers" Fact Sheet - Reminder - "The Basics of Internet-based PECOS for DMEPOS Suppliers" Fact Sheet (ICN 904283) is available in downloadable format. This fact sheet is designed to provide education on how Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers should enroll in the Medicare Program and maintain their enrollment information on Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). It includes information on how to complete an enrollment application using Internet-based PECOS and a list of frequently asked questions and resources.
  • November 20, 2014 - "Complying With Medical Record Documentation Requirements" Fact Sheet - Released - The "Complying With Medical Record Documentation Requirements" Fact Sheet (ICN 909160) was released and is now available in downloadable format. This fact sheet is designed to provide education on proper medical record documentation requirements. It includes information and resources to help Medicare providers understand how to provide accurate and supportive medical record documentation. This Medicare Learning Network® publication was developed in conjunction with the Comprehensive Error Rate Testing (CERT) Part A and Part B and Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Outreach & Education Task Forces in an effort to provide nationally-consistent education on topics of interest to health care professionals.
  • November 20, 2014 - "Hospital Reclassifications" Fact Sheet - Revised - The "Hospital Reclassifications" Fact Sheet (ICN 907243) was revised and is now available in downloadable format. This fact sheet is designed to provide education on hospital reclassifications. It includes the following information: urban to rural reclassification, geographic reclassification, Rural Referral Center status, Sole Community Hospital status, and Critical Access Hospital status.
  • November 20, 2014 - "Revised Centers for Medicare & Medicaid Services (CMS) 855R Application – Reassignment of Medicare Benefits" MLN Matters® Article - Released" - MLN Matters® Article #SE1432, "Revised Centers for Medicare & Medicaid Services (CMS) 855R Application – Reassignment of Medicare Benefits" was released and is now available in downloadable format. This article is designed to provide education on the revised CMS 855R application, which physicians, non-physician practitioners, providers, and suppliers must begin using on June 1, 2015. It includes information on how the form has changed and when it will be available for use on the CMS website.
  • November 20, 2014 - "Medicare Billing: 837I and Form CMS-1450" Fact Sheet - Revised" - The "Medicare Billing: 837I and Form CMS-1450" Fact Sheet (ICN 006926) was revised and is now available in downloadable format. This fact sheet is designed to provide education on electronic and paper claims for institutional providers as well as other health care professionals and suppliers. It includes information about Medicare claims submissions, coding, submitting accurate claims, when Medicare will accept a hard copy claim form, and timely filing.
  • November 20, 2014 - "Medicare Billing: 837P and Form CMS-1500" Fact Sheet - Revised" - The "Medicare Billing: 837P and Form CMS-1500" Fact Sheet (ICN 006976) was revised and is now available in downloadable format. This fact sheet is designed to provide education on electronic and paper claims for health care professionals and suppliers. It includes information about Medicare claims submissions, coding, submitting accurate claims, when Medicare will accept a hard copy claim form, timely filing, and where to submit Fee-For-Service (FFS) claims.
  • November 20, 2014 - "Evaluation and Management Services Guide" Educational Tool-Revised" - The "Evaluation and Management Services Guide" Educational Tool (ICN 006764) was revised and is now available in downloadable format. This guide is designed to provide education on evaluation and management services. It includes the following information: medical record documentation, evaluation and management billing and coding considerations, the "1995 Documentation Guidelines for Evaluation and Management Services," and the "1997 Documentation Guidelines for Evaluation and Management Services." Re-updated in August of 2017.
  • November 6, 2014 - "Skilled Nursing Facility Prospective Payment System" Fact Sheet - Revised - The "Skilled Nursing Facility Prospective Payment System" Fact Sheet (ICN 006821) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Skilled Nursing Facility Prospective Payment System (SNF PPS). It includes the following information: background and elements of the SNF PPS.
  • November 6, 2014 - "Inpatient Rehabilitation Facility Prospective Payment System" Fact Sheet - Revised - The "Inpatient Rehabilitation Facility Prospective Payment System" Fact Sheet (ICN 006847) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). It includes the following information: background, elements of the IRF PPS, payment updates, and IRF Quality Reporting Program.
  • October 16, 2014 - "Reading the Institutional Remittance Advice (RA)" Booklet - Released - The "Reading the Institutional Remittance Advice (RA)" Booklet (ICN 908326) was released and is now available in downloadable format. This booklet is designed to provide education on the institutional remittance advice (RA). It includes screen shots of an institutional RA with an explanation of what you will find on each screen.
  • October 16, 2014 - "Medicare Disproportionate Share Hospital" Fact Sheet - Revised - The "Medicare Disproportionate Share Hospital" Fact Sheet (ICN 006741) was revised and is now available in downloadable format. This fact sheet is designed to provide education on Medicare Disproportionate Share Hospitals (DSHs). It includes the following information: background; methods to qualify for the Medicare DSH adjustment; Affordable Care Act provision that impacts Medicare DSHs; Medicare Prescription Drug, Improvement, and Modernization Act provisions that impact Medicare DSHs; number of beds in hospital determination; Medicare DSH payment adjustment formulas; resources; and lists of helpful websites and Regional Office Rural Health Coordinators.
  • October 16, 2014 - "The Basics of Medicare Enrollment for Physicians and Other Part B Suppliers" Fact Sheet - Reminder - "The Basics of Medicare Enrollment for Physicians and Other Part B Suppliers" Fact Sheet (ICN 903768) is available in downloadable format. This fact sheet is designed to provide education on basic Medicare enrollment information and how to ensure physicians and other Part B suppliers are qualified and eligible to enroll in the Medicare Program. It includes information on how to enroll in the Medicare Program, how to report changes, and a list of resources.
  • October 9, 2014 - "Dual Eligible Beneficiaries Under the Medicare and Medicaid Programs" Fact Sheet - Revised The "Dual Eligible Beneficiaries Under the Medicare and Medicaid Programs" Fact Sheet (previously titled "Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles) At a Glance") (ICN 006977) was revised in September 2014 and is now available in downloadable format. This fact sheet is designed to provide education on dual eligible beneficiaries under the Medicare and Medicaid Programs. It includes the following information: the Medicare and Medicaid Programs; dual eligible beneficiaries; assignment; and prohibited billing.
  • October 2, 2014 - "Medicare Appeals Process" Fact Sheet - Revised - The "Medicare Appeals Process" Fact Sheet (ICN 006562) was revised and is now available in a downloadable format. This fact sheet is designed to provide education on the five levels of claim appeals in Original Medicare (Medicare Part A and Part B). It includes details explaining how the Medicare appeals process applies to providers, participating physicians, and participating suppliers, in addition to including more information on available appeals-related resources.
  • September 25, 2014 - "Medicare Billing Information for Rural Providers and Suppliers" Booklet - Revised - The "Medicare Billing Information for Rural Providers and Suppliers" Booklet (ICN 006762) was revised and is now available in downloadable format. To assist rural providers who have limited internet access, the "Medicare Billing Information for Rural Providers and Suppliers Text-Only" Booklet is available in text-only format. This booklet is designed to provide education on Medicare rural billing. It includes information for Critical Access Hospitals, Federally Qualified Health Centers, Home Health Agencies, Rural Health Clinics, Skilled Nursing Facilities, and Swing Beds.
  • September 25, 2014 - "Rural Health Clinic" Fact Sheet - Revised - The "Rural Health Clinic" Fact Sheet (ICN 006398) was revised and is now available in downloadable format. To assist rural providers who have limited internet access, the "Rural Health Clinic Text-Only" Fact Sheet is available in text-only format. This fact sheet is designed to provide education on Rural Health Clinics (RHC). It includes the following information: background, RHC services, Medicare certification as a RHC, RHC visits, RHC payments, cost reports, annual reconciliation, resources, and lists of helpful websites and Regional Office Rural Health Coordinators.
  • September 25, 2014 - "Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians" Fact Sheet - Revised - The "Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians" Fact Sheet (ICN 905645) was revised and is now available in a downloadable format. This fact sheet is designed to provide education for physicians on understanding how to comply with Federal laws that combat fraud and abuse and ensure appropriate quality medical care. It includes information on identifying "red flags" that could lead to potential liability in law enforcement and administrative actions.
  • September 25, 2014 - "Critical Access Hospital" Fact Sheet - Revised - The "Critical Access Hospital" Fact Sheet (ICN 006400) was revised and is now available in downloadable format. This fact sheet is designed to provide education on Critical Access Hospitals (CAHs). It includes the following information: background, CAH designation, CAH payments (including hospital inpatient admission certification requirements), additional Medicare payments, grants to States under the Medicare Rural Hospital Flexibility Program, resources, and lists of helpful websites and Regional Office Rural Health Coordinators.
  • September 18, 2014 - "Medicare Vision Services" Fact Sheet (ICN 907165) is designed to provide education on Medicare coverage and billing information for vision services. It includes specific information concerning coding requirements and an overview of coverage guidelines and exclusions.
  • September 18, 2014 - "Dual Eligible Beneficiaries Under the Medicare and Medicaid Programs" Fact Sheet - Revised - The "Dual Eligible Beneficiaries Under the Medicare and Medicaid Programs" Fact Sheet, previously titled Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles) At a Glance (ICN 006977), was revised and is now available in downloadable format. This fact sheet is designed to provide education on dual eligible beneficiaries under the Medicare and Medicaid Programs. It includes the following information: the Medicare and Medicaid Programs; deductibles, coinsurance, and copayments; dual eligible beneficiaries; assignment; and prohibited billing.
  • September 18, 2014 - "2014-2015 Influenza (Flu) Resources for Health Care Professionals" MLN Matters® Article - Released - MLN Matters® Special Edition Article #SE1431, "2014-2015 Influenza (Flu) Resources for Health Care Professionals" was released and is now available in downloadable format. This article is designed to provide education on resources and quick tips that health care professionals can use to help prevent the spread of the flu. It includes a list of educational resources designed to help health care professionals understand Medicare guidelines for seasonal flu vaccines and their administration.
  • September 15, 2014 - "Examining the Difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN)" MLN Matters® Article - Revised - MLN Matters® Special Edition Article #SE1216, "Examining the Difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN)" was revised and is now available in downloadable format. This article is designed to provide education on the differences between an NPI and a PTAN. It includes information about new enrollees, revalidation, the relationship between the NPI and PTAN, and how providers can protect their identity in the Provider Enrollment Chain & Ownership System (PECOS). The article was revised to add the "Where Can I Find My PTAN?" section on page 3.
  • September 4, 2014 - "Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports" Educational Tool - Released - The "Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports" Educational Tool (ICN 909008) was released and is now available in downloadable format. This product is designed to provide education on ground and air ambulance coverage and billing requirements that apply to destinations covered under the Medicare ambulance transport benefit. It includes the following information: the ambulance transport benefit; ambulance providers and suppliers; documentation requirements; coverage and billing requirements; and Advance Beneficiary Notice of Noncoverage.
  • September 4, 2014 - Medicare Vision Services" Fact Sheet - Revised



suggest a resource

If you know of a resource that should be included here (links, data, etc.) please contact us.

Free Demo
Schedule Your Demo Today
Pricing
Starting at $10/month
Sign In
Welcome back!