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Find-A-Code Links and Resources

Select the title to see a summary and a link to the full article.  some articles require a subscription to view.

Three Things To Know When Reporting Prolonged Services in 2023

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The Evaluation and Management (E/M) changes made in 2021 and again in 2023 brought about new CPT codes and guidelines for reporting prolonged services. Just as Medicare disagreed with CPT in the manner in which prolonged service times should be calculated, they did so again with the new 2023 changes. Here are three things you should know when reporting prolonged services for all E/M services.

2023 Procedure Coding Updates Are Just Weeks Away

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Even with such a low number of code changes headed our way in 2023, the talk is all about Evaluation and Management (E/M) and speculation about whether our facilities will be able to meet the challenges associated with such a big change. In 2021, when the initial round of E/M changes were announced, they were backed up with a couple of years to prepare for implementation but for facility, it was just months.

Leveraging Hierarchical Condition Category (HCC) Coding to Improve Overall Healthcare

by  Kem Tolliver, CMPE, CPC, CMOM

Diagnosis code usage is a major component of optimizing HCCs to improve overall healthcare. Readers will gain insight into how accurate diagnosis code usage and selection impacts reimbursement and overall healthcare.

Identifying the MEAT to Support Reporting Chronic Conditions in the Computer-Assisted-Coding (CAC) World

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The benefits of computer-assisted-coding (CAC) are great and understanding how to engage with the engine to ensure maximum coding efficiency is vital to the program's success for your organization. But how do you know when to accept an autosuggested code and when to ignore it, especially when it has to do with historical patient data?

3 Reasons Coders Should Review the ICD-10-CM Codes and Coding Guidelines Annually

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each year coding updates are published and more often than not, there can be anywhere from a few hundred to over a thousand new, revised, or deleted codes changes. Coders who take the time to review all of the changes instead of just those pertinent to their organization will accumulate knowledge and experience that helps them stand out in the coding industry as experts.

Understanding the Changes to the 2023 Evaluation & Management (E/M) Definitions for Chronic Conditions

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

This will be the third time since 2021 that the diagnosis complexity definitions have undergone significant changes. The initial 2021 changes were specific to Office and Other Outpatient E/M services and due to some confusion surrounding a few of the guidelines, updates to them were published by the AMA in April of 2021 with an effective date of January 1st. Because the 2023 E/M changes are more focused on the remaining E/M categories, especially in the hospital facility, new definitions were added and old definitions changed.

Medicare Updates -- SNF, Neurostimulators, Ambulance Fee Schedule and more (2022-10-20)

by  CMS - MLNConnects

Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...

Four Ways Your Organization Can Benefit from Gathering and Reporting Social Determinants of Health Data

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Providers who actively engage in collecting and reporting social determinants of health (SDoH) open avenues of identifying and treating their patients' population health trends. Pairing chronic conditions that are difficult to control with identified SDoH circumstances such as transportation or electricity insecurity, can help identify those patients who may wish to be healthier, but who are dealing with circumstances that prevent compliance, such as transportation or access to electricity, for instance.

Is the Patient Truly Ill? Why Random Audits Could Prevent Recoupment

by  Ronald Hirsch, MD FACP CHCQM CHRI

Three items are discussed in this article: First, performing random audits of critical care visits billed with CPT codes 99291 and 99292 to ensure the patient was truly critically ill, which could help avoid recoupment. Secondly, time will tell if rural hospitals will switch to the rural emergency hospital designation. Lastly, a 2023 OPPS proposed rule, CMS discusses creating a new payment category, paying for software as a service.

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.

Are You Prepared to Avoid Repayments

by  Raquel Shumway

Watchful care is needed when submitting claims. The Office of the Inspector General (OIG), after completing an audit on a Medicare Advantage Plan in August 2022, is now demanding repayment of claims to the tune of $3,518,465. Although the payer is contesting that amount, it is possible that they may begin demanding repayments from the providers to cover their costs of repayment.

Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.

How CMS Determines Which Telehealth Services are Risk Adjustable

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule

by  Amanda Ballif

The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.

Medicare Advantage and Part D Advance Notice Addresses Health Equity Initiatives Slated for 2023

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The current Administration constantly talks about health equity initiatives but what exactly does that mean for our providers and medical practices? Centers for Medicare and Medicaid Services (CMS) has published the 2023 Medicare Advantage and Part D Advance Noticed with significant focus on their definition of health equity and what is means to promote it within our individual practices and among health payer plans.

The Beginning of the End of COVID-19-Related Emergency Blanket Waivers

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.

HHS Leaders Urge States to Maximize Efforts to Support Children’s Mental Health

by  SAMSHA Newsroom

Today, agencies across the U.S. Department of Health and Human Services (HHS) issued a joint letter to states, tribes, and jurisdictions encouraging them to prioritize and maximize their efforts to strengthen children’s mental health and well-being. The letter, signed by leaders of the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Administration for Community Living (ACL), outlines HHS’ plans to support and facilitate state-level coordination across federal funding streams to advance and expand mental health services for children.

Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:

Sometimes it's the Little Coding Conundrums That Keep Us Concerned

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

We all experience coding situations that make us stop and rethink our coding path. Do we have the most current information on this situation? Does the payer contract change the way we must report the service? Are we missing something? Each of us experience simple to complex coding issues in our work and sometimes it is just nice to collaborate and discuss them openly to see how they may be resolved. Have you ever questioned the proper use of major depressive disorder codes versus the newly added (2021) depression, unspecified code? Take a look at what the OIG said about these codes and how the payer responded.

More Audits and More Problems

by  Ronald Hirsch, MD FACP CHCQM CHRI

More audits are coming, how do we stay compliant? We have been saying it but now it is happening. More audits are coming your way. One of the two CMS Recovery Audit Contractors seems to have taken on a business expansion plan. It appears they are contacting payers...
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Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

The Differences between Medicare and CPT, Reporting Prolonged Services

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Prolonged services reporting has changed for 2023. Tune into this informative webinar to review the changes including coding examples for payers following CPT guidelines as well as Medicare. Be sure you are prepared and that your documentation meets individual payer requirements.

2023 Annual Update Summary

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Be sure you are ready for 2023 with this review of the upcoming coding and reimbursement updates for 2023. This informative webinar discusses changes to CPT codes and guidelines including a summary of the changes to E/M services and an overview of changes to other CPT categories.

Medicare and the ABN for Chiropractic 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Dealing with the Little Coding Conundrums 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Coding 2022 Care Management Services 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Exclusions: What They Mean to You 

by  Ron Short, DC MCS-P CPC

Do Minor Procedures Feel like Major Work? 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Reporting Telemedicine Services by Aimee Wilcox 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Audit, Do-it-yourself 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Medicare Announces Coverage of Acupuncture Services for Chronic Low Back Pain 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Announces Coverage of Acupuncture Services for Chronic Low Back Pain

Proving Medical Necessity and Functional Improvement 

by  Ron Short, DC MCS-P CPC

Medicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement.

Inappropriate Payments Made to Chiropractors – An OIG Review 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

Chiropractic Manipulative Treatment and Medicare - Part 2 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

Coding and Auditing Wound Care 

by  Find-A-Code™

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.

What is RBRVS and How Can It Benefit Your Organization 

by  Find-A-Code™

What is RBRVS and How Can It Benefit Your Organization

How to Report MIPS 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

If eligible, you need to start reporting for MIPS by October 2th, 2017. Do you know who is exempt? Are you familiar with the quality measures that apply to chiropractors? Do you understand how to report on the Advancing Care Information or Improvement Activities? Don’t worry, Dr. Gwilliam has done all your homework and, in this presentation, you will get the crib notes containing just what you need to know. You don’t need to feel overwhelmed with Medicare regulations, you just need to know what to do.

How to Check NCCI Edits Using FindACode 

by  Find-A-Code™

How to Check NCCI Edits Using FindACode

Mighty MACRA! 

by  Find-A-Code™

Mighty MACRA!

The Future of Reimbursement - Medicare's Quality Payment Program 

by  Find-A-Code™

The Future of Reimbursement - Medicare's Quality Payment Program

Links and resources by topic.

Medicare
Practice Management

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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