CMS Resources - Part B
Regulation
- Centers for Medicare & Medicaid Services (CMS) Website
At this Website, you will find an assortment of CMS resources, such as manuals, an acronym finder, MLN Matters articles, HIPAA information, the Medicare Physician Fee Schedule, Frequently Asked Questions, and much more. - CMS Internet-Only Manual (IOM) System
At this CMS site, you will have access to the entire CMS online manual system. Effective October 1, 2003, CMS transitioned from a paper-based manual system to a Web-based system. The IOMs are a replica of the Agency's official record copy. They are CMS' program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations, and state survey agencies use the IOMs to administer CMS programs. They are also a good source of Medicare information for the general public. - CMS Transmittals
Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual. The cover page (or transmittal page) summarizes the new changed material, specifying what is changed. - CMS Manuals
The CMS Online Manual System is used by CMS program components, partners, contractors, and State Survey Agencies to administer CMS programs. It offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. - Regulations & Guidance
Visit this Web page for Medicare regulations and guidance, including information on health insurance reform, HIPAA, and legislation. - Medicare Learning Network (MLN)
This Website was established in response to increased Medicare health care professional usage of the Internet as a learning resource. The MLN site includes interactive Web-based Medicare learning courses, Satellite broadcasts, quick-reference guides, publications and many other tools to keep you up-to-date on Medicare. - MLN Matters Articles
MLN Matters is a series of national articles designed to inform the physician, provider, and supplier community about the latest changes to the Medicare Program (commonly referred to as Change Requests (CRs)). Articles are prepared in consultation with clinicians, billing experts, and CMS subject matter experts and are tailored in content and language to the specific provider type(s) affected by a particular Medicare change. Articles are developed to accompany recently released Medicare program instruction. - Federal Register
Published by the Office of the Federal Register, National Archives, and Records Administration (NARA), the Federal Register is the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations, as well as executive orders and other presidential documents. - CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by CMS on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare, including Program Memoranda, manual changes, and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the Update. At this Website, you can also sign up for the Quarterly Provider Update Listserv (electronic mailing list) to receive notification via your e-mail when regulations and program instructions are added throughout the quarter. - CMS Frequently Asked Questions (FAQs)
Check out the latest information on any topic through this useful CMS Website. See what subjects other providers have asked for clarification on, see CMS responses, print or e-mail them to others, or submit your own questions. You can search by pre-set categories and topics, or by your own words and phrases. Check regularly for the most up-to-date FAQs. - CMS Listservs
The CMS Listservs offer a way for you to receive consistent and accurate information regarding recent news, policy changes, and updates. These electronic mailing lists enable you to receive e-mails about the latest CMS Fee-for-Service (FFS) initiatives. All that is required to subscribe is your name and a valid e-mail address, and you can start receiving electronic updates automatically! For more details, download the Fact Sheet from the CMS Website
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Coverage and Guidance
- CMS Medicare Coverage Database
This Website contains a wealth of coverage information for your use. Several national databases are available on the site that allow you to search and view current and retired policies and coverage articles for any Medicare contractor, including Wisconsin Physicians Service (WPS). In addition, you can access the minutes from the Medicare Coverage Advisory Committee (MCAC) meetings, as well learn how the Medicare Modernization Act (MMA) affected Medicare policy. - Evaluation and Management (E/M) Services Documentation Guidelines
For detailed E/M guidelines please check out the "Documentation Guidelines - Evaluation and Management Services" from both 1995 and 1997. Additional E& M and much more general Medicare information can be found in CMS' 2007 Medicare Physician Guide. - Evaluation and Management (E/M) Services Guide
Provides E/M services information regarding medical record documentation, ICD-9-CM diagnosis codes, CPT codes, and key elements of service. For the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, see Chapter 5 of the Medicare Physician Guide on the CMS Website.
Billing Resources
- Forms
At this Website you will find a wide variety of CMS forms as well as filing instructions. Some of the forms available through this link are the CMS-1500, CMS-1450 (UB-92), and CMS-1491 forms. - ICD-9-CM Diagnosis Codes
This CMS Website contains the new, revised, and deleted ICD-9-CM diagnosis codes, as well as other ICD-9-CM resources. - Remittance Advice Reason and Remark Codes
This site contains descriptions for Remittance Advice reason and remark codes. - Remittance Advice (RA) Guide
The Remittance Advice Guide provides information about the types of RAs, the purpose of the RA, and the types of codes that appear on the RA. - MREP (Medicare Remit Easy Print)
CMS presents the MREP software to view and print the HIPAA-compliant 835 for providers and suppliers. This software, available free to Medicare providers and suppliers, can be used to access and print remittance advice information, including special reports, from the HIPAA 835. - Medicare Physician Fee Schedule Information
The Medicare Physician Fee Schedule Database (MPFSDB) or 'Database' is a great resource for information on whether a code is covered by Medicare. This resource is designed to provide information on services included in the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.) Please click here to view or print the Key to the MPFSDB Indicators. The full National Physician Fee Schedule Payment Amount File is available by following this link . - CMS DMEPOS Competitive Bidding Website
Visit this Website for comprehensive information on DMEPOS Competitive Bidding. - Competitive Acquisition for Part B Drugs & Biologicals
Visit this CMS Website and scroll to the bottom of the page to download the Beneficiary Fact Sheet for the Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals. Physicians who elect to participate in the CAP are required to provide the CAP Beneficiary Fact Sheet to Medicare beneficiaries who are receiving certain Part B physician-administered drugs. - Zip Code Changes and Zip Codes Requiring +4 Ext Files
- Approved Transplant Centers
This Website provides a list of facilities that are certified for Medicare payment of transplants for non-renal organs, along with the effective date of such certification. It includes a list of the Medicare Approved Transplant Centers for Heart, Lung and Heart-Lung, Liver, and Intestinal. - CMS PQRI Web Page
NPI (National Provider Identifier)
- National Provider Identifier (NPI)
At this Website, all providers may apply for their National Provider Identifier through Fox Systems. This Website also provides further information about the NPI. The NPI will replace health care provider identifiers in use today (e.g. UPIN) in standard health care transactions. Beginning May 23, 2005, all health care providers can apply for their National Provider Identifier. All HIPAA-covered entities except small health plans must begin using the NPI on May 23, 2007; small health plans have until May 23, 2008. - CMS NPI Website
If you bill Medicare for services, you need an NPI. Visit this Web page for information on the NPI, including how to apply and educational resources.
Providers/Suppliers - General Information
- CMS Central Provider Page
CMS wants to ensure providers and health care practitioners have quick access to accurate Medicare program information. In keeping with this goal, the provider-specific pages located at this site are a one-stop resource focused on the informational needs and interests of Medicare providers, including physicians and other practitioners. - CMS All Fee-For-Service Providers Information
Looking for information based on your provider type? This page has links to pages for Provider/Supplier Types, Provider/Supplier Resources, Educational Resources, and much more. - Physicians Information Resource for Medicare
A central Medicare resource for physicians, this Website offers a Physician Listserv, information about participation in the Medicare program, an Advance Beneficiary Quick Reference Guide, HIPAA information, and many other useful tools for the provider community. - Provider/Supplier Enrollment Website
Furnishes you with access to provider/supplier enrollment forms, specific requirements for provider/supplier types, manual instructions, troubleshooting, contact information, hot topics, and other pertinent information. - Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals
The Medicare Physician Guide offers general information about the Medicare Program, becoming a Medicare provider or supplier, Medicare payment policies, Medicare reimbursement, evaluation and management documentation, protecting the Medicare Trust Fund, inquiries, overpayments, and appeals.
Coordination of Benefits and Medicare Secondary Payer (MSP)
- COBA Medigap Claim-Based IDs on CMS' Coordination of Benefits Website
- COBC Trading Partner Customer Service Point-of-Contact List
- Medicare Secondary Payer Fact Sheets
CMS offers four new Medicare Secondary Payer (MSP) fact sheets helpful in explaining provider/billing clerk responsibilities. These fact sheets are available on the Medlearn Web page and cover issues such as MSP requirements, how to determine the primary payer, and guidelines for collecting, submitting, and updating beneficiary insurance information.
HIPAA (Health Insurance Portability & Accountability Act)
- HIPAA Information on the Centers for Medicare & Medicaid Services Website
This Website offers the latest HIPAA news, educational materials, Frequently Asked Questions, a glossary of terms, links to various other Websites and many other HIPAA-related resources. - HIPAA Information on the US Dept. Of Health and Human Services-Office for Civil Rights Website
This Website contains HIPAA fact sheets, instructions on how to file a health information privacy complaint, educational materials, Frequently Asked Questions, information on The Privacy Rule and many other HIPAA-related resources.
MCPSS (Medicare Contractor Provider Satisfaction Survey)
- Medicare Contractor Provider Satisfaction Survey (MCPSS)
The MCPSS is an annual survey of a nationally representative sample of physicians and provider population, conducted by the Centers for Medicare Management (CMM) for CMS through a contract with Westat. This site provides information about MCPSS to the physician and provider community, provider organizations and associations, and particularly to Medicare FFS Contractors, including Medicare Administrative Contractors (MACs). - CMS MCPSS
At this Web page, you will find MCPSS fact sheets, survey results, press releases, and other MCPSS information.
Page Last Updated: Monday, 29-Sep-2008 08:35:59 CDT
