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Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?

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Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?

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Watch out for New ICD-10-CM Codes

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New ICD Codes for: Low Back Pain, Cervicogenic Headache, Non-Radiographic Axial Spondyloarthritis (nr-axSpA), and Social Determinations of Health (SDOH). These codes became effective on October 1, 2021.

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​​Polysomnography Services Under OIG Scrutiny

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The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?

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IPPS and DRG's: What it Means

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Understanding hospital pricing can get complicated, so we have broken it down according to CMS and the acute Inpatient Prospective Payment System, also known as IPPS. Find-A-Code uses IPPS for inpatient pricing with our MS-DRG grouper. The following information comes from CMS.gov and answers the most common questions regarding DRGs ...

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Final Rule on Communications Technology and 2021 Physicians Fee Schedule

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To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...

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Cross-A-Code Instructions in Find-A-Code

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Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.

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Medicare Improper Payment Report for Chiropractic (2019)

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CMS audits claims on an annual basis to identify improper payments. These improper payments do not measure fraud. Rather, they estimate the share of payments that did not meet Medicare coverage, coding, and billing rules. In the most recent Improper Payment Report by specialty, chiropractic has the highest Part B improper payment ...

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Office of Inspector General Says Medicare Advantage Organizations are Denying Services Inappropriately

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We attended the recent virtual RISE National Conference and had the opportunity to listen to presenters share their knowledge about risk adjustment and HCC reporting and data validation. Among the presenters were representatives from the Office of Inspector General (OIG), who presented findings from encounter data from 2012-2016. They began ...

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New ABN Form is Here

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The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020.

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MEGA - NCCI Edit Changes - WHO Knew?

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There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE).  The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197  Deleted Medically Unlikely ...

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Changes in Medicare Advantage and Part D

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The Centers for Medicare & Medicaid Services finalized several changes in Medicare Advantage and Part D on Friday.  The Trump administration has finalized several changes in Medicare Advantage (MA) and Part D in anticipation of bid submissions on June 1. The Centers for Medicare & Medicaid Services (CMS) released  Friday that includes ...

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Where is the CCI Edit with Modifier 25 on E/M?

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If you are not seeing a CCI edit when reporting an E/M code with a certain procedure, it may be that there is no edit. CMS does not have a CCI edit for every CPT code, however, there are still general coding rules that must be followed.  The use of Modifier 25 is one example ...

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Additional Telehealth Changes Announced by CMS

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On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.

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COVID-19 Chiropractic Resources

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COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes.

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More Telehealth Changes Announced by CMS

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On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information

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Medicare Part D Coverage Gap (Donut Hole) Closes in 2020

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Overview of the Part D coverage gap, how it got closed, what the picture looks like for 2020, and long-term outlook.

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Medicare Begins Covering Acupuncture Services

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Medicare is changing their policy regarding coverage of acupuncture, but in order to provide these services, you must follow their rules.

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Medicare Announces Coverage of Acupuncture Services

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On January 21, 2020, a CMS Newsroom press-release read, This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...

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"Incident To" Services article by CMS1995 E/M Guidelines1997 E/M GuidelinesABN- Medicare Advance Written Notices of Noncoverage (October 2018)Accountable Care Organizations (ACO) - by CMSAdvanced Beneficiary Notice of Noncoverage (ABN) Form Instructions ToolBreach Notification Rule by HHSCare Plan Oversight (CPO) services information by CGS MedicareCGS Administrators, Jurisdiction 15 Part A - AppealsCGS Administrators, Jurisdiction 15 Part A - Audit & ReimbursementCGS Administrators, Jurisdiction 15 Part A - ClaimsCGS Administrators, Jurisdiction 15 Part A - Education & EventsCGS Administrators, Jurisdiction 15 Part A - FAQ TopicsCGS Administrators, Jurisdiction 15 Part A - Fee Schedule(s)CGS Administrators, Jurisdiction 15 Part A - FormsCGS Administrators, Jurisdiction 15 Part A - Medical PoliciesCGS Administrators, Jurisdiction 15 Part A - Medical ReviewCGS Administrators, Jurisdiction 15 Part A - News & PublicationsCGS Administrators, Jurisdiction 15 Part B - AppealsCGS Administrators, Jurisdiction 15 Part B - 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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 PortalFirst Coast Service Options, Jurisdiction N - AppealsFirst Coast Service Options, Jurisdiction N - BillingFirst Coast Service Options, Jurisdiction N - Claims ResourcesFirst Coast Service Options, Jurisdiction N - CodingFirst Coast Service Options, Jurisdiction N - Contact InformationFirst Coast Service Options, Jurisdiction N - EducationFirst Coast Service Options, Jurisdiction N - FAQsFirst Coast Service Options, Jurisdiction N - Fee Schedule(s)First Coast Service Options, Jurisdiction N - FormsFirst Coast Service Options, Jurisdiction N - Home PageFirst Coast Service Options, Jurisdiction N - Medical PolicyFirst Coast Service Options, Jurisdiction N - Provider EnrollmentFurther 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 - 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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 Government Services, Jurisdiction 6 - Home PageNational Government Services, Jurisdiction K - Home PageNational Supplier Clearinghouse home pageNCCI Instructions for Modifier 59Noridian, Jurisdiction E Part A - AppealsNoridian, Jurisdiction E Part A - Audit ReimbursementNoridian, Jurisdiction E Part A - ClaimsNoridian, Jurisdiction E Part A - Contact InformationNoridian, Jurisdiction E Part A - 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MedLearn articlePalmetto, Jurisdiction J - Events CalendarPalmetto, Jurisdiction J - Interactive ABNPalmetto, Jurisdiction J - Interactive UB-04Palmetto, Jurisdiction J Part A - AppealsPalmetto, Jurisdiction J Part A - Contact InformationPalmetto, Jurisdiction J Part A - FAQsPalmetto, Jurisdiction J Part A - Fee SchedulesPalmetto, Jurisdiction J Part A - FormsPalmetto, Jurisdiction J Part A - Home PagePalmetto, Jurisdiction J Part A - Medical PoliciesPalmetto, Jurisdiction J Part A - NewsPalmetto, Jurisdiction J Part A - Provider EnrollmentPalmetto, Jurisdiction J Part B - AppealsPalmetto, Jurisdiction J Part B - Contact InformationPalmetto, Jurisdiction J Part B - FAQsPalmetto, Jurisdiction J Part B - Fee Schedule Look UpPalmetto, Jurisdiction J Part B - FormsPalmetto, Jurisdiction J Part B - Home PagePalmetto, Jurisdiction J Part B - Medical PoliciesPalmetto, Jurisdiction J Part B - NewsPalmetto, Jurisdiction J Part B - Provider EnrollmentPalmetto, Jurisdiction M Part A - Appeal StatusPalmetto, Jurisdiction M Part A - 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New ProvidersPalmetto, Jurisdiction M Part B - Provider EnrollmentPalmetto, Jurisdiction M Part B - ResourcesParticipating 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 PoliciesThe CMS eHealth InitiativeThe Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1 BUpdated Mobile Applications (Apps) for Open PaymentsWPS GHA, Jurisdiction 5 - AppealsWPS GHA, Jurisdiction 5 - Claim ReviewWPS GHA, Jurisdiction 5 - Claims InformationWPS GHA, Jurisdiction 5 - Contact InformaitonWPS GHA, Jurisdiction 5 - Fee Schedule(s)WPS GHA, Jurisdiction 5 - FormsWPS GHA, Jurisdiction 5 - Medical PoliciesWPS GHA, Jurisdiction 5 - Provider EnrollmentWPS GHA, Jurisdiction 5 - TrainingsWPS GHA, Jurisdiction 8 - AppealsWPS GHA, Jurisdiction 8 - Claim ReviewWPS GHA, Jurisdiction 8 - Claims InformationWPS GHA, Jurisdiction 8 - Contact InformationWPS GHA, Jurisdiction 8 - Fee Schedule(s)WPS GHA, Jurisdiction 8 - FormsWPS GHA, Jurisdiction 8 - Medical PoliciesWPS GHA, Jurisdiction 8 - Provider EnrollmentWPS GHA, Jurisdiction 8 - TrainingsWPS 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



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