Official CMS Information for Medicare Fee-For-Service

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Catalog of Products

AvailableNovember 2009

R

Official CMS Information foredicare Fee-For-Service ProvidersM

INTRODUCTION

The Medicare Learning Network (MLN) is the destination for educational information for Medicare Fee-For-Service providers and is the brand name for official Centers for Medicare amp Medicaid Services (CMS) national provider education products designed to promote national consistency of Medicare provider information developed for CMS initiatives

The Medicare Learning Network (MLN) Catalog of Products contains all MLN products available to health care providers and is available in print as well as an online electronic version MLN products include articles educational tools brochures fact sheets training guides and web resources most of which can be viewed andor downloaded directly from the online version of the catalog Products that are available in hard copy only including CD ROMs and DVDs may be ordered from the Medicare Learning Network Product Ordering page located in the Related Links section at the bottom of the MLN Products page at httpwwwcmshhsgovMLNProducts on the CMS website All Medicare Learning Network educational and informational products are offered free of charge

How To Use The Medicare Learning Network (MLN) Catalog of Products

The MLN Catalog of Products is organized by product format such as MLN Matters Articles or Educational Tools There is a Special Initiatives section where providers will find topics such as E-Prescribing ICD-10 and Physician Quality Reporting Initiative (PQRI) Provider and Subject Indexes help identify products suggested for a specific type of provider or on a specific subject

Each educational and informational product listing includes the product title product description and available formats In the online version of the catalog the product title and listed formats link to the product or the product ordering page Some product listings also have a picture of the product For example

Official CMS Information forMedicare Fee-For-Service Providers

R

The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

TABLE OF CONTENTS GUIDES 2

ARTICLES 4

EDUCATIONAL TOOLS 5

BOOKLETS 8

BROCHURES 9

FACT SHEETS 12

TRAINING PRESENTATIONS 20

WEB-BASED TRAINING 20

SPECIAL INITIATIVES 22

HELPFUL RESOURCES 25

PROVIDER INDEX 26

SUBJECT INDEX 28

2

Official CMS Information for Medicare Fee-For-Service Providers

Guides

httpwwwcmshhsgovMLNProducts

Evaluation amp Management Services GuideThis guide offers evaluation and management services information about medical record documentation International Classification of Diseases and Current

Procedural Terminology codes and key elements of service 24 pages (July 2009) (ICN006764) Formats Available Downloadable only Suggested For Non-Physicians Practitioner (NPP) Physicians

The Guide to Medicare Preventive Services for Physicians Providers Suppliers and Other Health Care Professionals 3rd EditionThis guide provides information on Medicarersquos preventive benefits including coverage

frequency risk factors billing and reimbursement 283 pages (July 2009) (ICN006439) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

Medicare Physician Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide offers general information about the Medicare Program becoming a Medicare

provider or supplier Medicare reimbursement Medicare payment policies evaluation and management services protecting the Medicare Trust Fund inquiries overpayments and Fee-For-Service appeals 163 pages (October 2009) (ICN005933) Formats Available CD Rom Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

Physiciansrsquo Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant ServicesThis guide explains how Medicare helps pay for kidney dialysis and kidney transplant services under the Fee-

For-Service program 52 pages (January 2008) (ICN006558) Formats Available Downloadable only Suggested For NPP Physicians

ldquoI like being able to go to just one file to see all the available products from MLNrdquo ndash Provider

GUID

ES

httpwwwcmshhsgovMLNProducts

3Official CMS Information for Medicare Fee-For-Service Providers

Companion Facilitatorrsquos Guide to The Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide includes all the information and instructions

necessary to prepare for and present a Medicare Resident Practicing Physicians and Other Health Care Professional Training Program including instructions for facilitators customization guide two PowerPoint presentations with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools (October 2009) (ICN006352) Note See Facilitatorrsquos Kit for the Medicare Resident Practicing Physicians and Other Health Care Professional Training Program under the Educational Tools section Formats Available Downloadable only Suggested For Facilitators Hospitals Teacher

Understanding The Remittance Advice (RA) A Guide for Medicare Providers Physicians Suppliers and Billers 2nd EditionThis guide serves as a resource on how to read Remittance Advice Inside you

will find useful information on topics such as types of RAs the purpose of the RA and types of codes that appear on the RA 188 pages (October 2008) (ICN006745) Formats Available Hard Copy CD Rom Downloadable Suggested For All Medicare Fee-For-Service Providers

ldquoThis catalog is a good one-stop information booth for providersrsquo education products from Medicarerdquo ndash CMS Website User

GUIDES

Official CMS Information for Medicare Fee-For-Service Providers

4

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Articles

The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

ARTI

CLES

ldquoProviders love MLN Articles because they are easy to read short and direct with good graphicsrdquo ndash Philadelphia RO

httpwwwcmshhsgovMLNProducts

5Official CMS Information for Medicare Fee-For-Service Providers

CMS Website WheelThis website wheel is an informational resource that provides a variety of CMS Medicare-related websites The web addresses are listed by topic (ICN006212)

Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

Medicare Resident Practicing Physician and Other Health Care Professional Training Facilitator KitThis kit includes all the information and instructions necessary

to prepare for and present a Medicare Resident Practicing Physician and Other Health Care Professional Training Program including instructions for facilitators customization guide a PowerPoint presentation with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools The kit contains the following materials Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care Professionals (print and CD Rom formats) Facilitatorrsquos Guide (print and CD Rom formats) and Medicare Resident Practicing Physicians and Other Health Care Professional Training An Introduction Video (October 2008) (ICN006351) Note This product is only available to Facilitators Trainers Educators and Physicians Formats Available Hard Copy onlySuggested For Educators Facilitators Physicians Trainers

Medicare Billing Information for Rural Providers Suppliers and Physicians This product consists of charts that provide Medicare billing

information for Rural Health Clinics Federally Qualified Health Centers Skilled Nursing Facilities Home Health Agencies Critical Access Hospitals and Swing Beds 36 pages (October 2008) (ICN006762) Formats Available Downloadable Hard Copy Suggested For Clinics Critical Access Hospitals Home Health Agencies NPP Physicians Skilled Nursing Facilities

Medicare Learning Network (MLN)Guidance ToolThe Medicare Learning Network Guidance Tool is now available in CD ROM format and can be ordered through the Medicare Learning Network product ordering page This playable CD will streamline your search to find the most relevant and up-to-date links or URLs for national provider educational materials A tutorial will show you how to use the Guidance Tool to locate a new link (URL) refine your search as well as view download and order educational articles brochures fact sheets web-based training courses worksheets and videos Additionally the MLN Guidance Tool demonstrates how to navigate through sections of CMSrsquo Medicare Learning Network (January 2008) (ICN006843)Formats Available Hard Copy CD Rom Suggested For All Medicare Fee-For-Service Providers

Educational Tools

EDUCATIONAL TOOLS

6

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

EDUC

ATIO

NAL

TOOL

S

httpwwwcmshhsgovMLNProducts

7Official CMS Information for Medicare Fee-For-Service Providers

Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

EDUCATIONAL TOOLS

8

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Booklets

Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

BOOK

LETS

httpwwwcmshhsgovMLNProducts

9Official CMS Information for Medicare Fee-For-Service Providers

BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

Suggested For All Medicare Fee-For-Service Providers

Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

Suggested For All Medicare Fee-For-Service Providers

Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

(March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

(April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

BROCHURES

10

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

(July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

BROC

HURE

S

httpwwwcmshhsgovMLNProducts

11Official CMS Information for Medicare Fee-For-Service Providers

The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

BROCHURES

ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

12

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

FACT

SHE

ETS

httpwwwcmshhsgovMLNProducts

13Official CMS Information for Medicare Fee-For-Service Providers

Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

(December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

FACT SHEETS

14

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

(January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

FACT

SHE

ETS

httpwwwcmshhsgovMLNProducts

15Official CMS Information for Medicare Fee-For-Service Providers

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

FACT SHEETS

16

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

Downloadable only Suggested For NPP Physicians

Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

FACT

SHE

ETS

httpwwwcmshhsgovMLNProducts

17Official CMS Information for Medicare Fee-For-Service Providers

Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

FACT SHEETS

Official CMS Information for Medicare Fee-For-Service Providers

18

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

Downloadable only Suggested For Hospitals

Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

FACT

SHE

ETS

httpwwwcmshhsgovMLNProducts

19Official CMS Information for Medicare Fee-For-Service Providers

Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

FACT SHEETS

20

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Training Presentations

Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

WEB

-BAS

ED T

RAIN

ING

TRAI

NING

PRE

SENT

ATIO

NS

Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

httpwwwcmshhsgovMLNProducts

21Official CMS Information for Medicare Fee-For-Service Providers

Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

WEB-BASED TRAINING

22

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

SPEC

IAL

INIT

IATI

VES

httpwwwcmshhsgovMLNProducts

23Official CMS Information for Medicare Fee-For-Service Providers

General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

SPECIAL INITIATIVES

24

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

SPEC

IAL

INIT

IATI

VES

ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

httpwwwcmshhsgovMLNProducts

25Official CMS Information for Medicare Fee-For-Service Providers

Helpful Resources

Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

ICD-10httpwwwcmshhsgovICD10

Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

HELPFUL RESOURCES

26

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts26

All Medicare Fee-For-Service Providerspp 2-12 16-23 25

All Institutional Providerspp 9 14 20 21

All Part B Providerspp 11 13

All Rural Providerspp 5 7 18 19

Ambulance Supplierpp 10-12 17 20

Ambulatory Surgical Center (ASC)pp 9 12

Chiropractorp 12

Clinics Group Practicespp 5 7-9 13

Community Mental Health Centerp 14See All Institutional Providers

Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

Diagnostic Testing Facility Independent (IDTF)pp 7-9

Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

End Stage Renal Disease Facility (ESRD)pp 9 16 20

Facilitatorpp 3 5 6

Federally Qualified Health Center (FQHC)pp 18-19

PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

Hospicep 14

Hospitalpp 3 7-9 12-15 16-20

Indian Health Service Facility (IHS)pp 6 14 17

Inpatient Rehabilitation Facilitypp 9 15

Laboratory Independent Clinical (ICL)pp 7-9

Long Term Care Hospital (LTCH)p 15

Mammography Centerpp 7-8

Medical Billers Coderspp 17 22 23

Medicare Dependent Hospitalp 18

NPP Non-Physician Practitionerpp 2 5-25

Nurse Anesthetist (CRNA)pp 2 5-25

Nurse Midwife (CNM)pp 2 5-25

Nurse Practitioner (NP)pp 2 5-25

Nurse Specialist (CNS)pp 2 5-25

Pharmacy PharmacistSee Supplier

Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

PROV

IDER

INDE

X

httpwwwcmshhsgovMLNProducts

27Official CMS Information for Medicare Fee-For-Service Providers 27

Physicianpp 2 5-25

Physician Assistant (PA)pp 2 5-25

Psychologist Clinical See All Part B Providers

Psychiatric HospitalSee Hospital

Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

Rural Health Clinic (RHC)p19See also All Rural Providers

Rural Referral Center (RHC)p 19See also All Rural Providers

Skilled Nursing Facility (SNF)pp 17 19 21

Social Worker Clinicalp 7

Sole Community Hospital p 19See All Rural Providers and Hospital

Supplierpp 10-11 20

Teacherpp 3 5 6

X-Ray Facility Portablepp 7-8

NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

PROVIDER INDEX

ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

2828

Official CMS Information for Medicare Fee-For-Service Providers

httpwwwcmshhsgovMLNProducts

SUBJ

ECT

INDE

X

Appealsp 10

Articlesp 4

AV Fistulap 20

Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

Bone Mass Measurementp 9

Bookletsp 8

Bookmarkspp 6 7 22

Brochurespp 9-11

Cancer p 9

Certificate Of Medical Necessity (CMN)p 20

Chiropracticp 12

Claims Reviewp 8

Clinical Laboratory Improvement Amendments (CLIA)p 9

CMS Form 1500pp 13 20

Diabetesp10

Electronic Prescribing (E-Prescribing)pp 22 25

Email Subscription Service p12

Emergency Health Servicesp 17

SUBJECT INDEXEnrollment Reportingp 13

Evaluation And Management Services (EampM) p 2

Fact Sheetspp 12-19 22-24

Fee Schedulespp 12 16

Fraud And Abusepp 16 21

Glaucomap 10

Guidespp 2 3 25

Hospital Acquired Conditions (HAC)p 14

Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

Hospital Outpatient Prospective Payment System (OPPS)p 14

ICD-9-CM Diagnosis Coding pp 20 23

ICD-10-CM Procedure Codingp 23

Immunizationpp 7 9

Kidney Dialysis Transplant ESRDpp 2 16 20

Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

Manualsp 9

Medicaidp 11

httpwwwcmshhsgovMLNProducts

29Official CMS Information for Medicare Fee-For-Service Providers

SUBJECT INDEX

29

Medical Reviewp 11

Medicarepp 21 25

Medicare Learning Network (MLN)pp 4-6 18

Medicare Remit Easy Print (MREP)p 10

Medicare Secondary Payer (MSP)p 16

Outpatient Code Editor (OCE)p 21

Overpaymentsp 11

Physical Examination (IPPE)pp 7 10

Physician Fee Schedule (MPSF)p 16

Physician Quality Reporting Initiative (PQRI)pp 21 23 24

Podiatry Servicesp 16

Power Mobility Devices (PMDs)p 9

Practice Managementpp 2-3 7 11-12 16 21

Present On Admission (POA)p 17

Preventive Servicespp 2 6-11 21

Privacyp 16

Prospective Payment Systemspp 12-15 17 20

Quick Reference Chartspp 7 22 24

Rehabilitation Therapy p 17

Remittance Advice (RA)p 3

Rural Healthpp 5 7 18-19

Smoking Cessationp 11

SNF Consolidated Billingp 21

Special Initiativespp 22-24

Spell Of Illnessp 7

Swing Bedp 19

Telehealth Servicesp 19

UB-04pp 14 21

Undocumented Aliensp 17

Web Addresses Resourcespp 5 25

Web-Based Trainingpp 20 21

Womenrsquos Healthp 21

Official CMS Information for Medicare Fee-For-Service Providers

November 2009

ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

R

  • INTRODUCTION13
  • TABLE OF CONTENTS
  • GUIDES
  • ARTICLES
  • EDUCATIONAL TOOLS
  • BOOKLETS
  • BROCHURES
  • FACT SHEETS13
  • TRAINING PRESENTATIONS13
  • WEB-BASED TRAINING13
  • SPECIAL INITIATIVES13
  • HELPFUL RESOURCES13
  • PROVIDER INDEX
  • SUBJECT INDEX

    INTRODUCTION

    The Medicare Learning Network (MLN) is the destination for educational information for Medicare Fee-For-Service providers and is the brand name for official Centers for Medicare amp Medicaid Services (CMS) national provider education products designed to promote national consistency of Medicare provider information developed for CMS initiatives

    The Medicare Learning Network (MLN) Catalog of Products contains all MLN products available to health care providers and is available in print as well as an online electronic version MLN products include articles educational tools brochures fact sheets training guides and web resources most of which can be viewed andor downloaded directly from the online version of the catalog Products that are available in hard copy only including CD ROMs and DVDs may be ordered from the Medicare Learning Network Product Ordering page located in the Related Links section at the bottom of the MLN Products page at httpwwwcmshhsgovMLNProducts on the CMS website All Medicare Learning Network educational and informational products are offered free of charge

    How To Use The Medicare Learning Network (MLN) Catalog of Products

    The MLN Catalog of Products is organized by product format such as MLN Matters Articles or Educational Tools There is a Special Initiatives section where providers will find topics such as E-Prescribing ICD-10 and Physician Quality Reporting Initiative (PQRI) Provider and Subject Indexes help identify products suggested for a specific type of provider or on a specific subject

    Each educational and informational product listing includes the product title product description and available formats In the online version of the catalog the product title and listed formats link to the product or the product ordering page Some product listings also have a picture of the product For example

    Official CMS Information forMedicare Fee-For-Service Providers

    R

    The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

    TABLE OF CONTENTS GUIDES 2

    ARTICLES 4

    EDUCATIONAL TOOLS 5

    BOOKLETS 8

    BROCHURES 9

    FACT SHEETS 12

    TRAINING PRESENTATIONS 20

    WEB-BASED TRAINING 20

    SPECIAL INITIATIVES 22

    HELPFUL RESOURCES 25

    PROVIDER INDEX 26

    SUBJECT INDEX 28

    2

    Official CMS Information for Medicare Fee-For-Service Providers

    Guides

    httpwwwcmshhsgovMLNProducts

    Evaluation amp Management Services GuideThis guide offers evaluation and management services information about medical record documentation International Classification of Diseases and Current

    Procedural Terminology codes and key elements of service 24 pages (July 2009) (ICN006764) Formats Available Downloadable only Suggested For Non-Physicians Practitioner (NPP) Physicians

    The Guide to Medicare Preventive Services for Physicians Providers Suppliers and Other Health Care Professionals 3rd EditionThis guide provides information on Medicarersquos preventive benefits including coverage

    frequency risk factors billing and reimbursement 283 pages (July 2009) (ICN006439) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

    Medicare Physician Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide offers general information about the Medicare Program becoming a Medicare

    provider or supplier Medicare reimbursement Medicare payment policies evaluation and management services protecting the Medicare Trust Fund inquiries overpayments and Fee-For-Service appeals 163 pages (October 2009) (ICN005933) Formats Available CD Rom Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

    Physiciansrsquo Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant ServicesThis guide explains how Medicare helps pay for kidney dialysis and kidney transplant services under the Fee-

    For-Service program 52 pages (January 2008) (ICN006558) Formats Available Downloadable only Suggested For NPP Physicians

    ldquoI like being able to go to just one file to see all the available products from MLNrdquo ndash Provider

    GUID

    ES

    httpwwwcmshhsgovMLNProducts

    3Official CMS Information for Medicare Fee-For-Service Providers

    Companion Facilitatorrsquos Guide to The Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide includes all the information and instructions

    necessary to prepare for and present a Medicare Resident Practicing Physicians and Other Health Care Professional Training Program including instructions for facilitators customization guide two PowerPoint presentations with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools (October 2009) (ICN006352) Note See Facilitatorrsquos Kit for the Medicare Resident Practicing Physicians and Other Health Care Professional Training Program under the Educational Tools section Formats Available Downloadable only Suggested For Facilitators Hospitals Teacher

    Understanding The Remittance Advice (RA) A Guide for Medicare Providers Physicians Suppliers and Billers 2nd EditionThis guide serves as a resource on how to read Remittance Advice Inside you

    will find useful information on topics such as types of RAs the purpose of the RA and types of codes that appear on the RA 188 pages (October 2008) (ICN006745) Formats Available Hard Copy CD Rom Downloadable Suggested For All Medicare Fee-For-Service Providers

    ldquoThis catalog is a good one-stop information booth for providersrsquo education products from Medicarerdquo ndash CMS Website User

    GUIDES

    Official CMS Information for Medicare Fee-For-Service Providers

    4

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Articles

    The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

    ARTI

    CLES

    ldquoProviders love MLN Articles because they are easy to read short and direct with good graphicsrdquo ndash Philadelphia RO

    httpwwwcmshhsgovMLNProducts

    5Official CMS Information for Medicare Fee-For-Service Providers

    CMS Website WheelThis website wheel is an informational resource that provides a variety of CMS Medicare-related websites The web addresses are listed by topic (ICN006212)

    Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

    Medicare Resident Practicing Physician and Other Health Care Professional Training Facilitator KitThis kit includes all the information and instructions necessary

    to prepare for and present a Medicare Resident Practicing Physician and Other Health Care Professional Training Program including instructions for facilitators customization guide a PowerPoint presentation with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools The kit contains the following materials Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care Professionals (print and CD Rom formats) Facilitatorrsquos Guide (print and CD Rom formats) and Medicare Resident Practicing Physicians and Other Health Care Professional Training An Introduction Video (October 2008) (ICN006351) Note This product is only available to Facilitators Trainers Educators and Physicians Formats Available Hard Copy onlySuggested For Educators Facilitators Physicians Trainers

    Medicare Billing Information for Rural Providers Suppliers and Physicians This product consists of charts that provide Medicare billing

    information for Rural Health Clinics Federally Qualified Health Centers Skilled Nursing Facilities Home Health Agencies Critical Access Hospitals and Swing Beds 36 pages (October 2008) (ICN006762) Formats Available Downloadable Hard Copy Suggested For Clinics Critical Access Hospitals Home Health Agencies NPP Physicians Skilled Nursing Facilities

    Medicare Learning Network (MLN)Guidance ToolThe Medicare Learning Network Guidance Tool is now available in CD ROM format and can be ordered through the Medicare Learning Network product ordering page This playable CD will streamline your search to find the most relevant and up-to-date links or URLs for national provider educational materials A tutorial will show you how to use the Guidance Tool to locate a new link (URL) refine your search as well as view download and order educational articles brochures fact sheets web-based training courses worksheets and videos Additionally the MLN Guidance Tool demonstrates how to navigate through sections of CMSrsquo Medicare Learning Network (January 2008) (ICN006843)Formats Available Hard Copy CD Rom Suggested For All Medicare Fee-For-Service Providers

    Educational Tools

    EDUCATIONAL TOOLS

    6

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

    outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

    Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

    these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

    Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

    way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

    Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

    Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

    MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

    is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

    EDUC

    ATIO

    NAL

    TOOL

    S

    httpwwwcmshhsgovMLNProducts

    7Official CMS Information for Medicare Fee-For-Service Providers

    Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

    SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

    Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

    For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

    Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

    that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

    Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

    Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

    For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

    Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

    used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

    EDUCATIONAL TOOLS

    8

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Booklets

    Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

    NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

    ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

    BOOK

    LETS

    httpwwwcmshhsgovMLNProducts

    9Official CMS Information for Medicare Fee-For-Service Providers

    BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

    Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

    Suggested For All Medicare Fee-For-Service Providers

    Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

    Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

    Suggested For All Medicare Fee-For-Service Providers

    Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

    (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

    Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

    (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

    The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

    BROCHURES

    10

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

    Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

    (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

    Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

    Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

    Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

    The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

    and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

    Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

    BROC

    HURE

    S

    httpwwwcmshhsgovMLNProducts

    11Official CMS Information for Medicare Fee-For-Service Providers

    The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

    health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

    The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

    covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

    Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

    Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

    What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

    BROCHURES

    ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

    12

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

    payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

    Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

    chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

    Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

    Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

    are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

    Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

    CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

    FACT

    SHE

    ETS

    httpwwwcmshhsgovMLNProducts

    13Official CMS Information for Medicare Fee-For-Service Providers

    Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

    reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

    Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

    for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

    Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

    are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

    Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

    a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

    Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

    documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

    Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

    (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

    FACT SHEETS

    14

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

    Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

    (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

    Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

    fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

    Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

    4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

    Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

    information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

    Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

    the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

    Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

    the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

    FACT

    SHE

    ETS

    httpwwwcmshhsgovMLNProducts

    15Official CMS Information for Medicare Fee-For-Service Providers

    Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

    and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

    Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

    4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

    Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

    9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

    Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

    System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

    Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

    Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

    Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

    8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

    FACT SHEETS

    16

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

    Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

    on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

    Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

    Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

    Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

    Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

    Downloadable only Suggested For NPP Physicians

    Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

    settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

    Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

    separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

    ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

    FACT

    SHE

    ETS

    httpwwwcmshhsgovMLNProducts

    17Official CMS Information for Medicare Fee-For-Service Providers

    Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

    of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

    Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

    of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

    Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

    as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

    Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

    FACT SHEETS

    Official CMS Information for Medicare Fee-For-Service Providers

    18

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

    Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

    and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

    Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

    Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

    Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

    Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

    payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

    Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

    Downloadable only Suggested For Hospitals

    Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

    Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

    FACT

    SHE

    ETS

    httpwwwcmshhsgovMLNProducts

    19Official CMS Information for Medicare Fee-For-Service Providers

    Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

    Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

    Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

    Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

    Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

    or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

    Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

    4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

    Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

    sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

    FACT SHEETS

    20

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Training Presentations

    Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

    Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

    CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

    Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

    Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

    WEB

    -BAS

    ED T

    RAIN

    ING

    TRAI

    NING

    PRE

    SENT

    ATIO

    NS

    Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

    httpwwwcmshhsgovMLNProducts

    21Official CMS Information for Medicare Fee-For-Service Providers

    Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

    Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

    Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

    Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

    Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

    Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

    Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

    World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

    WEB-BASED TRAINING

    22

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

    2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

    2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

    2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

    ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

    ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

    ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

    Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

    ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

    SPEC

    IAL

    INIT

    IATI

    VES

    httpwwwcmshhsgovMLNProducts

    23Official CMS Information for Medicare Fee-For-Service Providers

    General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

    Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

    Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

    2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

    2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

    PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

    2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

    2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

    2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

    SPECIAL INITIATIVES

    24

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

    2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

    2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

    2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

    PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

    2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

    SPEC

    IAL

    INIT

    IATI

    VES

    ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

    httpwwwcmshhsgovMLNProducts

    25Official CMS Information for Medicare Fee-For-Service Providers

    Helpful Resources

    Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

    Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

    Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

    Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

    ICD-10httpwwwcmshhsgovICD10

    Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

    Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

    Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

    Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

    Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

    Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

    Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

    HELPFUL RESOURCES

    26

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts26

    All Medicare Fee-For-Service Providerspp 2-12 16-23 25

    All Institutional Providerspp 9 14 20 21

    All Part B Providerspp 11 13

    All Rural Providerspp 5 7 18 19

    Ambulance Supplierpp 10-12 17 20

    Ambulatory Surgical Center (ASC)pp 9 12

    Chiropractorp 12

    Clinics Group Practicespp 5 7-9 13

    Community Mental Health Centerp 14See All Institutional Providers

    Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

    Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

    Diagnostic Testing Facility Independent (IDTF)pp 7-9

    Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

    End Stage Renal Disease Facility (ESRD)pp 9 16 20

    Facilitatorpp 3 5 6

    Federally Qualified Health Center (FQHC)pp 18-19

    PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

    Hospicep 14

    Hospitalpp 3 7-9 12-15 16-20

    Indian Health Service Facility (IHS)pp 6 14 17

    Inpatient Rehabilitation Facilitypp 9 15

    Laboratory Independent Clinical (ICL)pp 7-9

    Long Term Care Hospital (LTCH)p 15

    Mammography Centerpp 7-8

    Medical Billers Coderspp 17 22 23

    Medicare Dependent Hospitalp 18

    NPP Non-Physician Practitionerpp 2 5-25

    Nurse Anesthetist (CRNA)pp 2 5-25

    Nurse Midwife (CNM)pp 2 5-25

    Nurse Practitioner (NP)pp 2 5-25

    Nurse Specialist (CNS)pp 2 5-25

    Pharmacy PharmacistSee Supplier

    Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

    PROV

    IDER

    INDE

    X

    httpwwwcmshhsgovMLNProducts

    27Official CMS Information for Medicare Fee-For-Service Providers 27

    Physicianpp 2 5-25

    Physician Assistant (PA)pp 2 5-25

    Psychologist Clinical See All Part B Providers

    Psychiatric HospitalSee Hospital

    Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

    Rural Health Clinic (RHC)p19See also All Rural Providers

    Rural Referral Center (RHC)p 19See also All Rural Providers

    Skilled Nursing Facility (SNF)pp 17 19 21

    Social Worker Clinicalp 7

    Sole Community Hospital p 19See All Rural Providers and Hospital

    Supplierpp 10-11 20

    Teacherpp 3 5 6

    X-Ray Facility Portablepp 7-8

    NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

    PROVIDER INDEX

    ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

    2828

    Official CMS Information for Medicare Fee-For-Service Providers

    httpwwwcmshhsgovMLNProducts

    SUBJ

    ECT

    INDE

    X

    Appealsp 10

    Articlesp 4

    AV Fistulap 20

    Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

    Bone Mass Measurementp 9

    Bookletsp 8

    Bookmarkspp 6 7 22

    Brochurespp 9-11

    Cancer p 9

    Certificate Of Medical Necessity (CMN)p 20

    Chiropracticp 12

    Claims Reviewp 8

    Clinical Laboratory Improvement Amendments (CLIA)p 9

    CMS Form 1500pp 13 20

    Diabetesp10

    Electronic Prescribing (E-Prescribing)pp 22 25

    Email Subscription Service p12

    Emergency Health Servicesp 17

    SUBJECT INDEXEnrollment Reportingp 13

    Evaluation And Management Services (EampM) p 2

    Fact Sheetspp 12-19 22-24

    Fee Schedulespp 12 16

    Fraud And Abusepp 16 21

    Glaucomap 10

    Guidespp 2 3 25

    Hospital Acquired Conditions (HAC)p 14

    Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

    Hospital Outpatient Prospective Payment System (OPPS)p 14

    ICD-9-CM Diagnosis Coding pp 20 23

    ICD-10-CM Procedure Codingp 23

    Immunizationpp 7 9

    Kidney Dialysis Transplant ESRDpp 2 16 20

    Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

    Manualsp 9

    Medicaidp 11

    httpwwwcmshhsgovMLNProducts

    29Official CMS Information for Medicare Fee-For-Service Providers

    SUBJECT INDEX

    29

    Medical Reviewp 11

    Medicarepp 21 25

    Medicare Learning Network (MLN)pp 4-6 18

    Medicare Remit Easy Print (MREP)p 10

    Medicare Secondary Payer (MSP)p 16

    Outpatient Code Editor (OCE)p 21

    Overpaymentsp 11

    Physical Examination (IPPE)pp 7 10

    Physician Fee Schedule (MPSF)p 16

    Physician Quality Reporting Initiative (PQRI)pp 21 23 24

    Podiatry Servicesp 16

    Power Mobility Devices (PMDs)p 9

    Practice Managementpp 2-3 7 11-12 16 21

    Present On Admission (POA)p 17

    Preventive Servicespp 2 6-11 21

    Privacyp 16

    Prospective Payment Systemspp 12-15 17 20

    Quick Reference Chartspp 7 22 24

    Rehabilitation Therapy p 17

    Remittance Advice (RA)p 3

    Rural Healthpp 5 7 18-19

    Smoking Cessationp 11

    SNF Consolidated Billingp 21

    Special Initiativespp 22-24

    Spell Of Illnessp 7

    Swing Bedp 19

    Telehealth Servicesp 19

    UB-04pp 14 21

    Undocumented Aliensp 17

    Web Addresses Resourcespp 5 25

    Web-Based Trainingpp 20 21

    Womenrsquos Healthp 21

    Official CMS Information for Medicare Fee-For-Service Providers

    November 2009

    ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

    R

    • INTRODUCTION13
    • TABLE OF CONTENTS
    • GUIDES
    • ARTICLES
    • EDUCATIONAL TOOLS
    • BOOKLETS
    • BROCHURES
    • FACT SHEETS13
    • TRAINING PRESENTATIONS13
    • WEB-BASED TRAINING13
    • SPECIAL INITIATIVES13
    • HELPFUL RESOURCES13
    • PROVIDER INDEX
    • SUBJECT INDEX

      TABLE OF CONTENTS GUIDES 2

      ARTICLES 4

      EDUCATIONAL TOOLS 5

      BOOKLETS 8

      BROCHURES 9

      FACT SHEETS 12

      TRAINING PRESENTATIONS 20

      WEB-BASED TRAINING 20

      SPECIAL INITIATIVES 22

      HELPFUL RESOURCES 25

      PROVIDER INDEX 26

      SUBJECT INDEX 28

      2

      Official CMS Information for Medicare Fee-For-Service Providers

      Guides

      httpwwwcmshhsgovMLNProducts

      Evaluation amp Management Services GuideThis guide offers evaluation and management services information about medical record documentation International Classification of Diseases and Current

      Procedural Terminology codes and key elements of service 24 pages (July 2009) (ICN006764) Formats Available Downloadable only Suggested For Non-Physicians Practitioner (NPP) Physicians

      The Guide to Medicare Preventive Services for Physicians Providers Suppliers and Other Health Care Professionals 3rd EditionThis guide provides information on Medicarersquos preventive benefits including coverage

      frequency risk factors billing and reimbursement 283 pages (July 2009) (ICN006439) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

      Medicare Physician Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide offers general information about the Medicare Program becoming a Medicare

      provider or supplier Medicare reimbursement Medicare payment policies evaluation and management services protecting the Medicare Trust Fund inquiries overpayments and Fee-For-Service appeals 163 pages (October 2009) (ICN005933) Formats Available CD Rom Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

      Physiciansrsquo Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant ServicesThis guide explains how Medicare helps pay for kidney dialysis and kidney transplant services under the Fee-

      For-Service program 52 pages (January 2008) (ICN006558) Formats Available Downloadable only Suggested For NPP Physicians

      ldquoI like being able to go to just one file to see all the available products from MLNrdquo ndash Provider

      GUID

      ES

      httpwwwcmshhsgovMLNProducts

      3Official CMS Information for Medicare Fee-For-Service Providers

      Companion Facilitatorrsquos Guide to The Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide includes all the information and instructions

      necessary to prepare for and present a Medicare Resident Practicing Physicians and Other Health Care Professional Training Program including instructions for facilitators customization guide two PowerPoint presentations with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools (October 2009) (ICN006352) Note See Facilitatorrsquos Kit for the Medicare Resident Practicing Physicians and Other Health Care Professional Training Program under the Educational Tools section Formats Available Downloadable only Suggested For Facilitators Hospitals Teacher

      Understanding The Remittance Advice (RA) A Guide for Medicare Providers Physicians Suppliers and Billers 2nd EditionThis guide serves as a resource on how to read Remittance Advice Inside you

      will find useful information on topics such as types of RAs the purpose of the RA and types of codes that appear on the RA 188 pages (October 2008) (ICN006745) Formats Available Hard Copy CD Rom Downloadable Suggested For All Medicare Fee-For-Service Providers

      ldquoThis catalog is a good one-stop information booth for providersrsquo education products from Medicarerdquo ndash CMS Website User

      GUIDES

      Official CMS Information for Medicare Fee-For-Service Providers

      4

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Articles

      The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

      ARTI

      CLES

      ldquoProviders love MLN Articles because they are easy to read short and direct with good graphicsrdquo ndash Philadelphia RO

      httpwwwcmshhsgovMLNProducts

      5Official CMS Information for Medicare Fee-For-Service Providers

      CMS Website WheelThis website wheel is an informational resource that provides a variety of CMS Medicare-related websites The web addresses are listed by topic (ICN006212)

      Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

      Medicare Resident Practicing Physician and Other Health Care Professional Training Facilitator KitThis kit includes all the information and instructions necessary

      to prepare for and present a Medicare Resident Practicing Physician and Other Health Care Professional Training Program including instructions for facilitators customization guide a PowerPoint presentation with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools The kit contains the following materials Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care Professionals (print and CD Rom formats) Facilitatorrsquos Guide (print and CD Rom formats) and Medicare Resident Practicing Physicians and Other Health Care Professional Training An Introduction Video (October 2008) (ICN006351) Note This product is only available to Facilitators Trainers Educators and Physicians Formats Available Hard Copy onlySuggested For Educators Facilitators Physicians Trainers

      Medicare Billing Information for Rural Providers Suppliers and Physicians This product consists of charts that provide Medicare billing

      information for Rural Health Clinics Federally Qualified Health Centers Skilled Nursing Facilities Home Health Agencies Critical Access Hospitals and Swing Beds 36 pages (October 2008) (ICN006762) Formats Available Downloadable Hard Copy Suggested For Clinics Critical Access Hospitals Home Health Agencies NPP Physicians Skilled Nursing Facilities

      Medicare Learning Network (MLN)Guidance ToolThe Medicare Learning Network Guidance Tool is now available in CD ROM format and can be ordered through the Medicare Learning Network product ordering page This playable CD will streamline your search to find the most relevant and up-to-date links or URLs for national provider educational materials A tutorial will show you how to use the Guidance Tool to locate a new link (URL) refine your search as well as view download and order educational articles brochures fact sheets web-based training courses worksheets and videos Additionally the MLN Guidance Tool demonstrates how to navigate through sections of CMSrsquo Medicare Learning Network (January 2008) (ICN006843)Formats Available Hard Copy CD Rom Suggested For All Medicare Fee-For-Service Providers

      Educational Tools

      EDUCATIONAL TOOLS

      6

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

      outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

      Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

      these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

      Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

      way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

      Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

      Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

      MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

      is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

      EDUC

      ATIO

      NAL

      TOOL

      S

      httpwwwcmshhsgovMLNProducts

      7Official CMS Information for Medicare Fee-For-Service Providers

      Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

      SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

      Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

      For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

      Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

      that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

      Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

      Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

      For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

      Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

      used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

      EDUCATIONAL TOOLS

      8

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Booklets

      Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

      NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

      ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

      BOOK

      LETS

      httpwwwcmshhsgovMLNProducts

      9Official CMS Information for Medicare Fee-For-Service Providers

      BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

      Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

      Suggested For All Medicare Fee-For-Service Providers

      Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

      Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

      Suggested For All Medicare Fee-For-Service Providers

      Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

      (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

      Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

      (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

      The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

      BROCHURES

      10

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

      Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

      (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

      Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

      Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

      Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

      The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

      and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

      Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

      BROC

      HURE

      S

      httpwwwcmshhsgovMLNProducts

      11Official CMS Information for Medicare Fee-For-Service Providers

      The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

      health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

      The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

      covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

      Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

      Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

      What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

      BROCHURES

      ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

      12

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

      payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

      Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

      chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

      Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

      Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

      are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

      Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

      CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

      FACT

      SHE

      ETS

      httpwwwcmshhsgovMLNProducts

      13Official CMS Information for Medicare Fee-For-Service Providers

      Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

      reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

      Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

      for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

      Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

      are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

      Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

      a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

      Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

      documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

      Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

      (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

      FACT SHEETS

      14

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

      Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

      (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

      Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

      fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

      Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

      4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

      Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

      information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

      Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

      the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

      Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

      the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

      FACT

      SHE

      ETS

      httpwwwcmshhsgovMLNProducts

      15Official CMS Information for Medicare Fee-For-Service Providers

      Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

      and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

      Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

      4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

      Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

      9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

      Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

      System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

      Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

      Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

      Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

      8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

      FACT SHEETS

      16

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

      Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

      on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

      Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

      Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

      Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

      Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

      Downloadable only Suggested For NPP Physicians

      Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

      settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

      Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

      separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

      ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

      FACT

      SHE

      ETS

      httpwwwcmshhsgovMLNProducts

      17Official CMS Information for Medicare Fee-For-Service Providers

      Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

      of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

      Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

      of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

      Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

      as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

      Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

      FACT SHEETS

      Official CMS Information for Medicare Fee-For-Service Providers

      18

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

      Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

      and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

      Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

      Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

      Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

      Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

      payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

      Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

      Downloadable only Suggested For Hospitals

      Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

      Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

      FACT

      SHE

      ETS

      httpwwwcmshhsgovMLNProducts

      19Official CMS Information for Medicare Fee-For-Service Providers

      Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

      Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

      Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

      Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

      Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

      or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

      Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

      4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

      Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

      sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

      FACT SHEETS

      20

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Training Presentations

      Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

      Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

      CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

      Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

      Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

      WEB

      -BAS

      ED T

      RAIN

      ING

      TRAI

      NING

      PRE

      SENT

      ATIO

      NS

      Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

      httpwwwcmshhsgovMLNProducts

      21Official CMS Information for Medicare Fee-For-Service Providers

      Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

      Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

      Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

      Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

      Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

      Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

      Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

      World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

      WEB-BASED TRAINING

      22

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

      2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

      2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

      2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

      ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

      ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

      ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

      Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

      ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

      SPEC

      IAL

      INIT

      IATI

      VES

      httpwwwcmshhsgovMLNProducts

      23Official CMS Information for Medicare Fee-For-Service Providers

      General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

      Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

      Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

      2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

      2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

      PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

      2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

      2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

      2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

      SPECIAL INITIATIVES

      24

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

      2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

      2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

      2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

      PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

      2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

      SPEC

      IAL

      INIT

      IATI

      VES

      ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

      httpwwwcmshhsgovMLNProducts

      25Official CMS Information for Medicare Fee-For-Service Providers

      Helpful Resources

      Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

      Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

      Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

      Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

      ICD-10httpwwwcmshhsgovICD10

      Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

      Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

      Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

      Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

      Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

      Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

      Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

      HELPFUL RESOURCES

      26

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts26

      All Medicare Fee-For-Service Providerspp 2-12 16-23 25

      All Institutional Providerspp 9 14 20 21

      All Part B Providerspp 11 13

      All Rural Providerspp 5 7 18 19

      Ambulance Supplierpp 10-12 17 20

      Ambulatory Surgical Center (ASC)pp 9 12

      Chiropractorp 12

      Clinics Group Practicespp 5 7-9 13

      Community Mental Health Centerp 14See All Institutional Providers

      Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

      Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

      Diagnostic Testing Facility Independent (IDTF)pp 7-9

      Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

      End Stage Renal Disease Facility (ESRD)pp 9 16 20

      Facilitatorpp 3 5 6

      Federally Qualified Health Center (FQHC)pp 18-19

      PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

      Hospicep 14

      Hospitalpp 3 7-9 12-15 16-20

      Indian Health Service Facility (IHS)pp 6 14 17

      Inpatient Rehabilitation Facilitypp 9 15

      Laboratory Independent Clinical (ICL)pp 7-9

      Long Term Care Hospital (LTCH)p 15

      Mammography Centerpp 7-8

      Medical Billers Coderspp 17 22 23

      Medicare Dependent Hospitalp 18

      NPP Non-Physician Practitionerpp 2 5-25

      Nurse Anesthetist (CRNA)pp 2 5-25

      Nurse Midwife (CNM)pp 2 5-25

      Nurse Practitioner (NP)pp 2 5-25

      Nurse Specialist (CNS)pp 2 5-25

      Pharmacy PharmacistSee Supplier

      Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

      PROV

      IDER

      INDE

      X

      httpwwwcmshhsgovMLNProducts

      27Official CMS Information for Medicare Fee-For-Service Providers 27

      Physicianpp 2 5-25

      Physician Assistant (PA)pp 2 5-25

      Psychologist Clinical See All Part B Providers

      Psychiatric HospitalSee Hospital

      Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

      Rural Health Clinic (RHC)p19See also All Rural Providers

      Rural Referral Center (RHC)p 19See also All Rural Providers

      Skilled Nursing Facility (SNF)pp 17 19 21

      Social Worker Clinicalp 7

      Sole Community Hospital p 19See All Rural Providers and Hospital

      Supplierpp 10-11 20

      Teacherpp 3 5 6

      X-Ray Facility Portablepp 7-8

      NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

      PROVIDER INDEX

      ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

      2828

      Official CMS Information for Medicare Fee-For-Service Providers

      httpwwwcmshhsgovMLNProducts

      SUBJ

      ECT

      INDE

      X

      Appealsp 10

      Articlesp 4

      AV Fistulap 20

      Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

      Bone Mass Measurementp 9

      Bookletsp 8

      Bookmarkspp 6 7 22

      Brochurespp 9-11

      Cancer p 9

      Certificate Of Medical Necessity (CMN)p 20

      Chiropracticp 12

      Claims Reviewp 8

      Clinical Laboratory Improvement Amendments (CLIA)p 9

      CMS Form 1500pp 13 20

      Diabetesp10

      Electronic Prescribing (E-Prescribing)pp 22 25

      Email Subscription Service p12

      Emergency Health Servicesp 17

      SUBJECT INDEXEnrollment Reportingp 13

      Evaluation And Management Services (EampM) p 2

      Fact Sheetspp 12-19 22-24

      Fee Schedulespp 12 16

      Fraud And Abusepp 16 21

      Glaucomap 10

      Guidespp 2 3 25

      Hospital Acquired Conditions (HAC)p 14

      Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

      Hospital Outpatient Prospective Payment System (OPPS)p 14

      ICD-9-CM Diagnosis Coding pp 20 23

      ICD-10-CM Procedure Codingp 23

      Immunizationpp 7 9

      Kidney Dialysis Transplant ESRDpp 2 16 20

      Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

      Manualsp 9

      Medicaidp 11

      httpwwwcmshhsgovMLNProducts

      29Official CMS Information for Medicare Fee-For-Service Providers

      SUBJECT INDEX

      29

      Medical Reviewp 11

      Medicarepp 21 25

      Medicare Learning Network (MLN)pp 4-6 18

      Medicare Remit Easy Print (MREP)p 10

      Medicare Secondary Payer (MSP)p 16

      Outpatient Code Editor (OCE)p 21

      Overpaymentsp 11

      Physical Examination (IPPE)pp 7 10

      Physician Fee Schedule (MPSF)p 16

      Physician Quality Reporting Initiative (PQRI)pp 21 23 24

      Podiatry Servicesp 16

      Power Mobility Devices (PMDs)p 9

      Practice Managementpp 2-3 7 11-12 16 21

      Present On Admission (POA)p 17

      Preventive Servicespp 2 6-11 21

      Privacyp 16

      Prospective Payment Systemspp 12-15 17 20

      Quick Reference Chartspp 7 22 24

      Rehabilitation Therapy p 17

      Remittance Advice (RA)p 3

      Rural Healthpp 5 7 18-19

      Smoking Cessationp 11

      SNF Consolidated Billingp 21

      Special Initiativespp 22-24

      Spell Of Illnessp 7

      Swing Bedp 19

      Telehealth Servicesp 19

      UB-04pp 14 21

      Undocumented Aliensp 17

      Web Addresses Resourcespp 5 25

      Web-Based Trainingpp 20 21

      Womenrsquos Healthp 21

      Official CMS Information for Medicare Fee-For-Service Providers

      November 2009

      ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

      R

      • INTRODUCTION13
      • TABLE OF CONTENTS
      • GUIDES
      • ARTICLES
      • EDUCATIONAL TOOLS
      • BOOKLETS
      • BROCHURES
      • FACT SHEETS13
      • TRAINING PRESENTATIONS13
      • WEB-BASED TRAINING13
      • SPECIAL INITIATIVES13
      • HELPFUL RESOURCES13
      • PROVIDER INDEX
      • SUBJECT INDEX

        2

        Official CMS Information for Medicare Fee-For-Service Providers

        Guides

        httpwwwcmshhsgovMLNProducts

        Evaluation amp Management Services GuideThis guide offers evaluation and management services information about medical record documentation International Classification of Diseases and Current

        Procedural Terminology codes and key elements of service 24 pages (July 2009) (ICN006764) Formats Available Downloadable only Suggested For Non-Physicians Practitioner (NPP) Physicians

        The Guide to Medicare Preventive Services for Physicians Providers Suppliers and Other Health Care Professionals 3rd EditionThis guide provides information on Medicarersquos preventive benefits including coverage

        frequency risk factors billing and reimbursement 283 pages (July 2009) (ICN006439) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

        Medicare Physician Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide offers general information about the Medicare Program becoming a Medicare

        provider or supplier Medicare reimbursement Medicare payment policies evaluation and management services protecting the Medicare Trust Fund inquiries overpayments and Fee-For-Service appeals 163 pages (October 2009) (ICN005933) Formats Available CD Rom Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

        Physiciansrsquo Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant ServicesThis guide explains how Medicare helps pay for kidney dialysis and kidney transplant services under the Fee-

        For-Service program 52 pages (January 2008) (ICN006558) Formats Available Downloadable only Suggested For NPP Physicians

        ldquoI like being able to go to just one file to see all the available products from MLNrdquo ndash Provider

        GUID

        ES

        httpwwwcmshhsgovMLNProducts

        3Official CMS Information for Medicare Fee-For-Service Providers

        Companion Facilitatorrsquos Guide to The Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide includes all the information and instructions

        necessary to prepare for and present a Medicare Resident Practicing Physicians and Other Health Care Professional Training Program including instructions for facilitators customization guide two PowerPoint presentations with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools (October 2009) (ICN006352) Note See Facilitatorrsquos Kit for the Medicare Resident Practicing Physicians and Other Health Care Professional Training Program under the Educational Tools section Formats Available Downloadable only Suggested For Facilitators Hospitals Teacher

        Understanding The Remittance Advice (RA) A Guide for Medicare Providers Physicians Suppliers and Billers 2nd EditionThis guide serves as a resource on how to read Remittance Advice Inside you

        will find useful information on topics such as types of RAs the purpose of the RA and types of codes that appear on the RA 188 pages (October 2008) (ICN006745) Formats Available Hard Copy CD Rom Downloadable Suggested For All Medicare Fee-For-Service Providers

        ldquoThis catalog is a good one-stop information booth for providersrsquo education products from Medicarerdquo ndash CMS Website User

        GUIDES

        Official CMS Information for Medicare Fee-For-Service Providers

        4

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Articles

        The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

        ARTI

        CLES

        ldquoProviders love MLN Articles because they are easy to read short and direct with good graphicsrdquo ndash Philadelphia RO

        httpwwwcmshhsgovMLNProducts

        5Official CMS Information for Medicare Fee-For-Service Providers

        CMS Website WheelThis website wheel is an informational resource that provides a variety of CMS Medicare-related websites The web addresses are listed by topic (ICN006212)

        Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

        Medicare Resident Practicing Physician and Other Health Care Professional Training Facilitator KitThis kit includes all the information and instructions necessary

        to prepare for and present a Medicare Resident Practicing Physician and Other Health Care Professional Training Program including instructions for facilitators customization guide a PowerPoint presentation with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools The kit contains the following materials Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care Professionals (print and CD Rom formats) Facilitatorrsquos Guide (print and CD Rom formats) and Medicare Resident Practicing Physicians and Other Health Care Professional Training An Introduction Video (October 2008) (ICN006351) Note This product is only available to Facilitators Trainers Educators and Physicians Formats Available Hard Copy onlySuggested For Educators Facilitators Physicians Trainers

        Medicare Billing Information for Rural Providers Suppliers and Physicians This product consists of charts that provide Medicare billing

        information for Rural Health Clinics Federally Qualified Health Centers Skilled Nursing Facilities Home Health Agencies Critical Access Hospitals and Swing Beds 36 pages (October 2008) (ICN006762) Formats Available Downloadable Hard Copy Suggested For Clinics Critical Access Hospitals Home Health Agencies NPP Physicians Skilled Nursing Facilities

        Medicare Learning Network (MLN)Guidance ToolThe Medicare Learning Network Guidance Tool is now available in CD ROM format and can be ordered through the Medicare Learning Network product ordering page This playable CD will streamline your search to find the most relevant and up-to-date links or URLs for national provider educational materials A tutorial will show you how to use the Guidance Tool to locate a new link (URL) refine your search as well as view download and order educational articles brochures fact sheets web-based training courses worksheets and videos Additionally the MLN Guidance Tool demonstrates how to navigate through sections of CMSrsquo Medicare Learning Network (January 2008) (ICN006843)Formats Available Hard Copy CD Rom Suggested For All Medicare Fee-For-Service Providers

        Educational Tools

        EDUCATIONAL TOOLS

        6

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

        outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

        Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

        these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

        Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

        way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

        Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

        Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

        MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

        is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

        EDUC

        ATIO

        NAL

        TOOL

        S

        httpwwwcmshhsgovMLNProducts

        7Official CMS Information for Medicare Fee-For-Service Providers

        Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

        SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

        Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

        For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

        Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

        that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

        Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

        Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

        For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

        Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

        used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

        EDUCATIONAL TOOLS

        8

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Booklets

        Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

        NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

        ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

        BOOK

        LETS

        httpwwwcmshhsgovMLNProducts

        9Official CMS Information for Medicare Fee-For-Service Providers

        BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

        Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

        Suggested For All Medicare Fee-For-Service Providers

        Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

        Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

        Suggested For All Medicare Fee-For-Service Providers

        Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

        (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

        Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

        (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

        The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

        BROCHURES

        10

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

        Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

        (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

        Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

        Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

        Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

        The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

        and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

        Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

        BROC

        HURE

        S

        httpwwwcmshhsgovMLNProducts

        11Official CMS Information for Medicare Fee-For-Service Providers

        The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

        health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

        The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

        covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

        Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

        Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

        What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

        BROCHURES

        ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

        12

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

        payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

        Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

        chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

        Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

        Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

        are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

        Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

        CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

        FACT

        SHE

        ETS

        httpwwwcmshhsgovMLNProducts

        13Official CMS Information for Medicare Fee-For-Service Providers

        Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

        reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

        Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

        for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

        Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

        are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

        Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

        a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

        Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

        documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

        Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

        (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

        FACT SHEETS

        14

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

        Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

        (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

        Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

        fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

        Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

        4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

        Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

        information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

        Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

        the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

        Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

        the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

        FACT

        SHE

        ETS

        httpwwwcmshhsgovMLNProducts

        15Official CMS Information for Medicare Fee-For-Service Providers

        Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

        and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

        Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

        4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

        Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

        9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

        Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

        System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

        Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

        Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

        Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

        8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

        FACT SHEETS

        16

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

        Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

        on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

        Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

        Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

        Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

        Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

        Downloadable only Suggested For NPP Physicians

        Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

        settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

        Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

        separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

        ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

        FACT

        SHE

        ETS

        httpwwwcmshhsgovMLNProducts

        17Official CMS Information for Medicare Fee-For-Service Providers

        Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

        of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

        Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

        of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

        Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

        as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

        Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

        FACT SHEETS

        Official CMS Information for Medicare Fee-For-Service Providers

        18

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

        Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

        and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

        Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

        Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

        Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

        Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

        payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

        Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

        Downloadable only Suggested For Hospitals

        Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

        Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

        FACT

        SHE

        ETS

        httpwwwcmshhsgovMLNProducts

        19Official CMS Information for Medicare Fee-For-Service Providers

        Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

        Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

        Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

        Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

        Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

        or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

        Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

        4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

        Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

        sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

        FACT SHEETS

        20

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Training Presentations

        Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

        Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

        CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

        Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

        Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

        WEB

        -BAS

        ED T

        RAIN

        ING

        TRAI

        NING

        PRE

        SENT

        ATIO

        NS

        Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

        httpwwwcmshhsgovMLNProducts

        21Official CMS Information for Medicare Fee-For-Service Providers

        Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

        Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

        Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

        Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

        Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

        Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

        Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

        World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

        WEB-BASED TRAINING

        22

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

        2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

        2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

        2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

        ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

        ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

        ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

        Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

        ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

        SPEC

        IAL

        INIT

        IATI

        VES

        httpwwwcmshhsgovMLNProducts

        23Official CMS Information for Medicare Fee-For-Service Providers

        General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

        Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

        Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

        2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

        2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

        PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

        2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

        2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

        2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

        SPECIAL INITIATIVES

        24

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

        2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

        2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

        2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

        PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

        2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

        SPEC

        IAL

        INIT

        IATI

        VES

        ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

        httpwwwcmshhsgovMLNProducts

        25Official CMS Information for Medicare Fee-For-Service Providers

        Helpful Resources

        Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

        Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

        Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

        Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

        ICD-10httpwwwcmshhsgovICD10

        Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

        Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

        Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

        Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

        Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

        Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

        Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

        HELPFUL RESOURCES

        26

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts26

        All Medicare Fee-For-Service Providerspp 2-12 16-23 25

        All Institutional Providerspp 9 14 20 21

        All Part B Providerspp 11 13

        All Rural Providerspp 5 7 18 19

        Ambulance Supplierpp 10-12 17 20

        Ambulatory Surgical Center (ASC)pp 9 12

        Chiropractorp 12

        Clinics Group Practicespp 5 7-9 13

        Community Mental Health Centerp 14See All Institutional Providers

        Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

        Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

        Diagnostic Testing Facility Independent (IDTF)pp 7-9

        Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

        End Stage Renal Disease Facility (ESRD)pp 9 16 20

        Facilitatorpp 3 5 6

        Federally Qualified Health Center (FQHC)pp 18-19

        PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

        Hospicep 14

        Hospitalpp 3 7-9 12-15 16-20

        Indian Health Service Facility (IHS)pp 6 14 17

        Inpatient Rehabilitation Facilitypp 9 15

        Laboratory Independent Clinical (ICL)pp 7-9

        Long Term Care Hospital (LTCH)p 15

        Mammography Centerpp 7-8

        Medical Billers Coderspp 17 22 23

        Medicare Dependent Hospitalp 18

        NPP Non-Physician Practitionerpp 2 5-25

        Nurse Anesthetist (CRNA)pp 2 5-25

        Nurse Midwife (CNM)pp 2 5-25

        Nurse Practitioner (NP)pp 2 5-25

        Nurse Specialist (CNS)pp 2 5-25

        Pharmacy PharmacistSee Supplier

        Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

        PROV

        IDER

        INDE

        X

        httpwwwcmshhsgovMLNProducts

        27Official CMS Information for Medicare Fee-For-Service Providers 27

        Physicianpp 2 5-25

        Physician Assistant (PA)pp 2 5-25

        Psychologist Clinical See All Part B Providers

        Psychiatric HospitalSee Hospital

        Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

        Rural Health Clinic (RHC)p19See also All Rural Providers

        Rural Referral Center (RHC)p 19See also All Rural Providers

        Skilled Nursing Facility (SNF)pp 17 19 21

        Social Worker Clinicalp 7

        Sole Community Hospital p 19See All Rural Providers and Hospital

        Supplierpp 10-11 20

        Teacherpp 3 5 6

        X-Ray Facility Portablepp 7-8

        NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

        PROVIDER INDEX

        ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

        2828

        Official CMS Information for Medicare Fee-For-Service Providers

        httpwwwcmshhsgovMLNProducts

        SUBJ

        ECT

        INDE

        X

        Appealsp 10

        Articlesp 4

        AV Fistulap 20

        Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

        Bone Mass Measurementp 9

        Bookletsp 8

        Bookmarkspp 6 7 22

        Brochurespp 9-11

        Cancer p 9

        Certificate Of Medical Necessity (CMN)p 20

        Chiropracticp 12

        Claims Reviewp 8

        Clinical Laboratory Improvement Amendments (CLIA)p 9

        CMS Form 1500pp 13 20

        Diabetesp10

        Electronic Prescribing (E-Prescribing)pp 22 25

        Email Subscription Service p12

        Emergency Health Servicesp 17

        SUBJECT INDEXEnrollment Reportingp 13

        Evaluation And Management Services (EampM) p 2

        Fact Sheetspp 12-19 22-24

        Fee Schedulespp 12 16

        Fraud And Abusepp 16 21

        Glaucomap 10

        Guidespp 2 3 25

        Hospital Acquired Conditions (HAC)p 14

        Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

        Hospital Outpatient Prospective Payment System (OPPS)p 14

        ICD-9-CM Diagnosis Coding pp 20 23

        ICD-10-CM Procedure Codingp 23

        Immunizationpp 7 9

        Kidney Dialysis Transplant ESRDpp 2 16 20

        Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

        Manualsp 9

        Medicaidp 11

        httpwwwcmshhsgovMLNProducts

        29Official CMS Information for Medicare Fee-For-Service Providers

        SUBJECT INDEX

        29

        Medical Reviewp 11

        Medicarepp 21 25

        Medicare Learning Network (MLN)pp 4-6 18

        Medicare Remit Easy Print (MREP)p 10

        Medicare Secondary Payer (MSP)p 16

        Outpatient Code Editor (OCE)p 21

        Overpaymentsp 11

        Physical Examination (IPPE)pp 7 10

        Physician Fee Schedule (MPSF)p 16

        Physician Quality Reporting Initiative (PQRI)pp 21 23 24

        Podiatry Servicesp 16

        Power Mobility Devices (PMDs)p 9

        Practice Managementpp 2-3 7 11-12 16 21

        Present On Admission (POA)p 17

        Preventive Servicespp 2 6-11 21

        Privacyp 16

        Prospective Payment Systemspp 12-15 17 20

        Quick Reference Chartspp 7 22 24

        Rehabilitation Therapy p 17

        Remittance Advice (RA)p 3

        Rural Healthpp 5 7 18-19

        Smoking Cessationp 11

        SNF Consolidated Billingp 21

        Special Initiativespp 22-24

        Spell Of Illnessp 7

        Swing Bedp 19

        Telehealth Servicesp 19

        UB-04pp 14 21

        Undocumented Aliensp 17

        Web Addresses Resourcespp 5 25

        Web-Based Trainingpp 20 21

        Womenrsquos Healthp 21

        Official CMS Information for Medicare Fee-For-Service Providers

        November 2009

        ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

        R

        • INTRODUCTION13
        • TABLE OF CONTENTS
        • GUIDES
        • ARTICLES
        • EDUCATIONAL TOOLS
        • BOOKLETS
        • BROCHURES
        • FACT SHEETS13
        • TRAINING PRESENTATIONS13
        • WEB-BASED TRAINING13
        • SPECIAL INITIATIVES13
        • HELPFUL RESOURCES13
        • PROVIDER INDEX
        • SUBJECT INDEX

          httpwwwcmshhsgovMLNProducts

          3Official CMS Information for Medicare Fee-For-Service Providers

          Companion Facilitatorrsquos Guide to The Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care ProfessionalsThis guide includes all the information and instructions

          necessary to prepare for and present a Medicare Resident Practicing Physicians and Other Health Care Professional Training Program including instructions for facilitators customization guide two PowerPoint presentations with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools (October 2009) (ICN006352) Note See Facilitatorrsquos Kit for the Medicare Resident Practicing Physicians and Other Health Care Professional Training Program under the Educational Tools section Formats Available Downloadable only Suggested For Facilitators Hospitals Teacher

          Understanding The Remittance Advice (RA) A Guide for Medicare Providers Physicians Suppliers and Billers 2nd EditionThis guide serves as a resource on how to read Remittance Advice Inside you

          will find useful information on topics such as types of RAs the purpose of the RA and types of codes that appear on the RA 188 pages (October 2008) (ICN006745) Formats Available Hard Copy CD Rom Downloadable Suggested For All Medicare Fee-For-Service Providers

          ldquoThis catalog is a good one-stop information booth for providersrsquo education products from Medicarerdquo ndash CMS Website User

          GUIDES

          Official CMS Information for Medicare Fee-For-Service Providers

          4

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Articles

          The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

          ARTI

          CLES

          ldquoProviders love MLN Articles because they are easy to read short and direct with good graphicsrdquo ndash Philadelphia RO

          httpwwwcmshhsgovMLNProducts

          5Official CMS Information for Medicare Fee-For-Service Providers

          CMS Website WheelThis website wheel is an informational resource that provides a variety of CMS Medicare-related websites The web addresses are listed by topic (ICN006212)

          Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

          Medicare Resident Practicing Physician and Other Health Care Professional Training Facilitator KitThis kit includes all the information and instructions necessary

          to prepare for and present a Medicare Resident Practicing Physician and Other Health Care Professional Training Program including instructions for facilitators customization guide a PowerPoint presentation with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools The kit contains the following materials Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care Professionals (print and CD Rom formats) Facilitatorrsquos Guide (print and CD Rom formats) and Medicare Resident Practicing Physicians and Other Health Care Professional Training An Introduction Video (October 2008) (ICN006351) Note This product is only available to Facilitators Trainers Educators and Physicians Formats Available Hard Copy onlySuggested For Educators Facilitators Physicians Trainers

          Medicare Billing Information for Rural Providers Suppliers and Physicians This product consists of charts that provide Medicare billing

          information for Rural Health Clinics Federally Qualified Health Centers Skilled Nursing Facilities Home Health Agencies Critical Access Hospitals and Swing Beds 36 pages (October 2008) (ICN006762) Formats Available Downloadable Hard Copy Suggested For Clinics Critical Access Hospitals Home Health Agencies NPP Physicians Skilled Nursing Facilities

          Medicare Learning Network (MLN)Guidance ToolThe Medicare Learning Network Guidance Tool is now available in CD ROM format and can be ordered through the Medicare Learning Network product ordering page This playable CD will streamline your search to find the most relevant and up-to-date links or URLs for national provider educational materials A tutorial will show you how to use the Guidance Tool to locate a new link (URL) refine your search as well as view download and order educational articles brochures fact sheets web-based training courses worksheets and videos Additionally the MLN Guidance Tool demonstrates how to navigate through sections of CMSrsquo Medicare Learning Network (January 2008) (ICN006843)Formats Available Hard Copy CD Rom Suggested For All Medicare Fee-For-Service Providers

          Educational Tools

          EDUCATIONAL TOOLS

          6

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

          outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

          Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

          these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

          Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

          way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

          Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

          Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

          MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

          is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

          EDUC

          ATIO

          NAL

          TOOL

          S

          httpwwwcmshhsgovMLNProducts

          7Official CMS Information for Medicare Fee-For-Service Providers

          Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

          SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

          Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

          For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

          Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

          that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

          Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

          Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

          For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

          Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

          used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

          EDUCATIONAL TOOLS

          8

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Booklets

          Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

          NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

          ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

          BOOK

          LETS

          httpwwwcmshhsgovMLNProducts

          9Official CMS Information for Medicare Fee-For-Service Providers

          BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

          Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

          Suggested For All Medicare Fee-For-Service Providers

          Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

          Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

          Suggested For All Medicare Fee-For-Service Providers

          Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

          (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

          Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

          (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

          The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

          BROCHURES

          10

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

          Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

          (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

          Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

          Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

          Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

          The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

          and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

          Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

          BROC

          HURE

          S

          httpwwwcmshhsgovMLNProducts

          11Official CMS Information for Medicare Fee-For-Service Providers

          The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

          health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

          The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

          covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

          Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

          Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

          What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

          BROCHURES

          ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

          12

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

          payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

          Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

          chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

          Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

          Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

          are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

          Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

          CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

          FACT

          SHE

          ETS

          httpwwwcmshhsgovMLNProducts

          13Official CMS Information for Medicare Fee-For-Service Providers

          Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

          reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

          Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

          for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

          Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

          are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

          Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

          a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

          Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

          documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

          Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

          (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

          FACT SHEETS

          14

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

          Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

          (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

          Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

          fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

          Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

          4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

          Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

          information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

          Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

          the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

          Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

          the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

          FACT

          SHE

          ETS

          httpwwwcmshhsgovMLNProducts

          15Official CMS Information for Medicare Fee-For-Service Providers

          Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

          and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

          Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

          4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

          Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

          9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

          Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

          System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

          Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

          Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

          Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

          8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

          FACT SHEETS

          16

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

          Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

          on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

          Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

          Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

          Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

          Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

          Downloadable only Suggested For NPP Physicians

          Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

          settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

          Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

          separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

          ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

          FACT

          SHE

          ETS

          httpwwwcmshhsgovMLNProducts

          17Official CMS Information for Medicare Fee-For-Service Providers

          Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

          of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

          Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

          of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

          Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

          as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

          Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

          FACT SHEETS

          Official CMS Information for Medicare Fee-For-Service Providers

          18

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

          Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

          and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

          Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

          Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

          Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

          Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

          payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

          Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

          Downloadable only Suggested For Hospitals

          Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

          Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

          FACT

          SHE

          ETS

          httpwwwcmshhsgovMLNProducts

          19Official CMS Information for Medicare Fee-For-Service Providers

          Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

          Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

          Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

          Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

          Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

          or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

          Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

          4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

          Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

          sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

          FACT SHEETS

          20

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Training Presentations

          Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

          Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

          CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

          Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

          Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

          WEB

          -BAS

          ED T

          RAIN

          ING

          TRAI

          NING

          PRE

          SENT

          ATIO

          NS

          Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

          httpwwwcmshhsgovMLNProducts

          21Official CMS Information for Medicare Fee-For-Service Providers

          Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

          Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

          Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

          Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

          Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

          Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

          Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

          World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

          WEB-BASED TRAINING

          22

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

          2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

          2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

          2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

          ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

          ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

          ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

          Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

          ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

          SPEC

          IAL

          INIT

          IATI

          VES

          httpwwwcmshhsgovMLNProducts

          23Official CMS Information for Medicare Fee-For-Service Providers

          General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

          Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

          Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

          2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

          2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

          PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

          2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

          2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

          2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

          SPECIAL INITIATIVES

          24

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

          2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

          2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

          2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

          PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

          2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

          SPEC

          IAL

          INIT

          IATI

          VES

          ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

          httpwwwcmshhsgovMLNProducts

          25Official CMS Information for Medicare Fee-For-Service Providers

          Helpful Resources

          Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

          Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

          Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

          Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

          ICD-10httpwwwcmshhsgovICD10

          Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

          Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

          Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

          Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

          Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

          Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

          Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

          HELPFUL RESOURCES

          26

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts26

          All Medicare Fee-For-Service Providerspp 2-12 16-23 25

          All Institutional Providerspp 9 14 20 21

          All Part B Providerspp 11 13

          All Rural Providerspp 5 7 18 19

          Ambulance Supplierpp 10-12 17 20

          Ambulatory Surgical Center (ASC)pp 9 12

          Chiropractorp 12

          Clinics Group Practicespp 5 7-9 13

          Community Mental Health Centerp 14See All Institutional Providers

          Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

          Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

          Diagnostic Testing Facility Independent (IDTF)pp 7-9

          Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

          End Stage Renal Disease Facility (ESRD)pp 9 16 20

          Facilitatorpp 3 5 6

          Federally Qualified Health Center (FQHC)pp 18-19

          PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

          Hospicep 14

          Hospitalpp 3 7-9 12-15 16-20

          Indian Health Service Facility (IHS)pp 6 14 17

          Inpatient Rehabilitation Facilitypp 9 15

          Laboratory Independent Clinical (ICL)pp 7-9

          Long Term Care Hospital (LTCH)p 15

          Mammography Centerpp 7-8

          Medical Billers Coderspp 17 22 23

          Medicare Dependent Hospitalp 18

          NPP Non-Physician Practitionerpp 2 5-25

          Nurse Anesthetist (CRNA)pp 2 5-25

          Nurse Midwife (CNM)pp 2 5-25

          Nurse Practitioner (NP)pp 2 5-25

          Nurse Specialist (CNS)pp 2 5-25

          Pharmacy PharmacistSee Supplier

          Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

          PROV

          IDER

          INDE

          X

          httpwwwcmshhsgovMLNProducts

          27Official CMS Information for Medicare Fee-For-Service Providers 27

          Physicianpp 2 5-25

          Physician Assistant (PA)pp 2 5-25

          Psychologist Clinical See All Part B Providers

          Psychiatric HospitalSee Hospital

          Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

          Rural Health Clinic (RHC)p19See also All Rural Providers

          Rural Referral Center (RHC)p 19See also All Rural Providers

          Skilled Nursing Facility (SNF)pp 17 19 21

          Social Worker Clinicalp 7

          Sole Community Hospital p 19See All Rural Providers and Hospital

          Supplierpp 10-11 20

          Teacherpp 3 5 6

          X-Ray Facility Portablepp 7-8

          NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

          PROVIDER INDEX

          ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

          2828

          Official CMS Information for Medicare Fee-For-Service Providers

          httpwwwcmshhsgovMLNProducts

          SUBJ

          ECT

          INDE

          X

          Appealsp 10

          Articlesp 4

          AV Fistulap 20

          Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

          Bone Mass Measurementp 9

          Bookletsp 8

          Bookmarkspp 6 7 22

          Brochurespp 9-11

          Cancer p 9

          Certificate Of Medical Necessity (CMN)p 20

          Chiropracticp 12

          Claims Reviewp 8

          Clinical Laboratory Improvement Amendments (CLIA)p 9

          CMS Form 1500pp 13 20

          Diabetesp10

          Electronic Prescribing (E-Prescribing)pp 22 25

          Email Subscription Service p12

          Emergency Health Servicesp 17

          SUBJECT INDEXEnrollment Reportingp 13

          Evaluation And Management Services (EampM) p 2

          Fact Sheetspp 12-19 22-24

          Fee Schedulespp 12 16

          Fraud And Abusepp 16 21

          Glaucomap 10

          Guidespp 2 3 25

          Hospital Acquired Conditions (HAC)p 14

          Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

          Hospital Outpatient Prospective Payment System (OPPS)p 14

          ICD-9-CM Diagnosis Coding pp 20 23

          ICD-10-CM Procedure Codingp 23

          Immunizationpp 7 9

          Kidney Dialysis Transplant ESRDpp 2 16 20

          Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

          Manualsp 9

          Medicaidp 11

          httpwwwcmshhsgovMLNProducts

          29Official CMS Information for Medicare Fee-For-Service Providers

          SUBJECT INDEX

          29

          Medical Reviewp 11

          Medicarepp 21 25

          Medicare Learning Network (MLN)pp 4-6 18

          Medicare Remit Easy Print (MREP)p 10

          Medicare Secondary Payer (MSP)p 16

          Outpatient Code Editor (OCE)p 21

          Overpaymentsp 11

          Physical Examination (IPPE)pp 7 10

          Physician Fee Schedule (MPSF)p 16

          Physician Quality Reporting Initiative (PQRI)pp 21 23 24

          Podiatry Servicesp 16

          Power Mobility Devices (PMDs)p 9

          Practice Managementpp 2-3 7 11-12 16 21

          Present On Admission (POA)p 17

          Preventive Servicespp 2 6-11 21

          Privacyp 16

          Prospective Payment Systemspp 12-15 17 20

          Quick Reference Chartspp 7 22 24

          Rehabilitation Therapy p 17

          Remittance Advice (RA)p 3

          Rural Healthpp 5 7 18-19

          Smoking Cessationp 11

          SNF Consolidated Billingp 21

          Special Initiativespp 22-24

          Spell Of Illnessp 7

          Swing Bedp 19

          Telehealth Servicesp 19

          UB-04pp 14 21

          Undocumented Aliensp 17

          Web Addresses Resourcespp 5 25

          Web-Based Trainingpp 20 21

          Womenrsquos Healthp 21

          Official CMS Information for Medicare Fee-For-Service Providers

          November 2009

          ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

          R

          • INTRODUCTION13
          • TABLE OF CONTENTS
          • GUIDES
          • ARTICLES
          • EDUCATIONAL TOOLS
          • BOOKLETS
          • BROCHURES
          • FACT SHEETS13
          • TRAINING PRESENTATIONS13
          • WEB-BASED TRAINING13
          • SPECIAL INITIATIVES13
          • HELPFUL RESOURCES13
          • PROVIDER INDEX
          • SUBJECT INDEX

            4

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Articles

            The National Medicare Learning Network Article Series (MLN Matters) MLN Matters is the place where Medicare Fee-For-Service health care professionals can find nationally consistent articles on new and revised Medicare policies The site is updated frequently Please bookmark httpwwwcmshhsgovMLNMattersArticles so you may visit it often Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

            ARTI

            CLES

            ldquoProviders love MLN Articles because they are easy to read short and direct with good graphicsrdquo ndash Philadelphia RO

            httpwwwcmshhsgovMLNProducts

            5Official CMS Information for Medicare Fee-For-Service Providers

            CMS Website WheelThis website wheel is an informational resource that provides a variety of CMS Medicare-related websites The web addresses are listed by topic (ICN006212)

            Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

            Medicare Resident Practicing Physician and Other Health Care Professional Training Facilitator KitThis kit includes all the information and instructions necessary

            to prepare for and present a Medicare Resident Practicing Physician and Other Health Care Professional Training Program including instructions for facilitators customization guide a PowerPoint presentation with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools The kit contains the following materials Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care Professionals (print and CD Rom formats) Facilitatorrsquos Guide (print and CD Rom formats) and Medicare Resident Practicing Physicians and Other Health Care Professional Training An Introduction Video (October 2008) (ICN006351) Note This product is only available to Facilitators Trainers Educators and Physicians Formats Available Hard Copy onlySuggested For Educators Facilitators Physicians Trainers

            Medicare Billing Information for Rural Providers Suppliers and Physicians This product consists of charts that provide Medicare billing

            information for Rural Health Clinics Federally Qualified Health Centers Skilled Nursing Facilities Home Health Agencies Critical Access Hospitals and Swing Beds 36 pages (October 2008) (ICN006762) Formats Available Downloadable Hard Copy Suggested For Clinics Critical Access Hospitals Home Health Agencies NPP Physicians Skilled Nursing Facilities

            Medicare Learning Network (MLN)Guidance ToolThe Medicare Learning Network Guidance Tool is now available in CD ROM format and can be ordered through the Medicare Learning Network product ordering page This playable CD will streamline your search to find the most relevant and up-to-date links or URLs for national provider educational materials A tutorial will show you how to use the Guidance Tool to locate a new link (URL) refine your search as well as view download and order educational articles brochures fact sheets web-based training courses worksheets and videos Additionally the MLN Guidance Tool demonstrates how to navigate through sections of CMSrsquo Medicare Learning Network (January 2008) (ICN006843)Formats Available Hard Copy CD Rom Suggested For All Medicare Fee-For-Service Providers

            Educational Tools

            EDUCATIONAL TOOLS

            6

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

            outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

            Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

            these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

            Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

            way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

            Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

            Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

            MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

            is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

            EDUC

            ATIO

            NAL

            TOOL

            S

            httpwwwcmshhsgovMLNProducts

            7Official CMS Information for Medicare Fee-For-Service Providers

            Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

            SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

            Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

            For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

            Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

            that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

            Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

            Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

            For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

            Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

            used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

            EDUCATIONAL TOOLS

            8

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Booklets

            Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

            NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

            ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

            BOOK

            LETS

            httpwwwcmshhsgovMLNProducts

            9Official CMS Information for Medicare Fee-For-Service Providers

            BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

            Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

            Suggested For All Medicare Fee-For-Service Providers

            Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

            Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

            Suggested For All Medicare Fee-For-Service Providers

            Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

            (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

            Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

            (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

            The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

            BROCHURES

            10

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

            Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

            (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

            Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

            Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

            Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

            The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

            and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

            Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

            BROC

            HURE

            S

            httpwwwcmshhsgovMLNProducts

            11Official CMS Information for Medicare Fee-For-Service Providers

            The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

            health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

            The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

            covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

            Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

            Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

            What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

            BROCHURES

            ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

            12

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

            payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

            Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

            chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

            Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

            Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

            are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

            Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

            CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

            FACT

            SHE

            ETS

            httpwwwcmshhsgovMLNProducts

            13Official CMS Information for Medicare Fee-For-Service Providers

            Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

            reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

            Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

            for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

            Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

            are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

            Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

            a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

            Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

            documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

            Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

            (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

            FACT SHEETS

            14

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

            Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

            (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

            Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

            fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

            Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

            4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

            Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

            information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

            Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

            the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

            Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

            the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

            FACT

            SHE

            ETS

            httpwwwcmshhsgovMLNProducts

            15Official CMS Information for Medicare Fee-For-Service Providers

            Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

            and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

            Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

            4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

            Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

            9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

            Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

            System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

            Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

            Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

            Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

            8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

            FACT SHEETS

            16

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

            Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

            on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

            Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

            Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

            Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

            Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

            Downloadable only Suggested For NPP Physicians

            Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

            settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

            Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

            separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

            ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

            FACT

            SHE

            ETS

            httpwwwcmshhsgovMLNProducts

            17Official CMS Information for Medicare Fee-For-Service Providers

            Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

            of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

            Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

            of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

            Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

            as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

            Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

            FACT SHEETS

            Official CMS Information for Medicare Fee-For-Service Providers

            18

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

            Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

            and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

            Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

            Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

            Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

            Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

            payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

            Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

            Downloadable only Suggested For Hospitals

            Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

            Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

            FACT

            SHE

            ETS

            httpwwwcmshhsgovMLNProducts

            19Official CMS Information for Medicare Fee-For-Service Providers

            Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

            Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

            Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

            Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

            Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

            or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

            Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

            4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

            Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

            sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

            FACT SHEETS

            20

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Training Presentations

            Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

            Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

            CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

            Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

            Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

            WEB

            -BAS

            ED T

            RAIN

            ING

            TRAI

            NING

            PRE

            SENT

            ATIO

            NS

            Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

            httpwwwcmshhsgovMLNProducts

            21Official CMS Information for Medicare Fee-For-Service Providers

            Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

            Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

            Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

            Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

            Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

            Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

            Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

            World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

            WEB-BASED TRAINING

            22

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

            2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

            2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

            2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

            ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

            ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

            ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

            Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

            ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

            SPEC

            IAL

            INIT

            IATI

            VES

            httpwwwcmshhsgovMLNProducts

            23Official CMS Information for Medicare Fee-For-Service Providers

            General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

            Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

            Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

            2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

            2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

            PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

            2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

            2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

            2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

            SPECIAL INITIATIVES

            24

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

            2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

            2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

            2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

            PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

            2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

            SPEC

            IAL

            INIT

            IATI

            VES

            ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

            httpwwwcmshhsgovMLNProducts

            25Official CMS Information for Medicare Fee-For-Service Providers

            Helpful Resources

            Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

            Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

            Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

            Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

            ICD-10httpwwwcmshhsgovICD10

            Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

            Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

            Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

            Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

            Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

            Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

            Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

            HELPFUL RESOURCES

            26

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts26

            All Medicare Fee-For-Service Providerspp 2-12 16-23 25

            All Institutional Providerspp 9 14 20 21

            All Part B Providerspp 11 13

            All Rural Providerspp 5 7 18 19

            Ambulance Supplierpp 10-12 17 20

            Ambulatory Surgical Center (ASC)pp 9 12

            Chiropractorp 12

            Clinics Group Practicespp 5 7-9 13

            Community Mental Health Centerp 14See All Institutional Providers

            Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

            Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

            Diagnostic Testing Facility Independent (IDTF)pp 7-9

            Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

            End Stage Renal Disease Facility (ESRD)pp 9 16 20

            Facilitatorpp 3 5 6

            Federally Qualified Health Center (FQHC)pp 18-19

            PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

            Hospicep 14

            Hospitalpp 3 7-9 12-15 16-20

            Indian Health Service Facility (IHS)pp 6 14 17

            Inpatient Rehabilitation Facilitypp 9 15

            Laboratory Independent Clinical (ICL)pp 7-9

            Long Term Care Hospital (LTCH)p 15

            Mammography Centerpp 7-8

            Medical Billers Coderspp 17 22 23

            Medicare Dependent Hospitalp 18

            NPP Non-Physician Practitionerpp 2 5-25

            Nurse Anesthetist (CRNA)pp 2 5-25

            Nurse Midwife (CNM)pp 2 5-25

            Nurse Practitioner (NP)pp 2 5-25

            Nurse Specialist (CNS)pp 2 5-25

            Pharmacy PharmacistSee Supplier

            Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

            PROV

            IDER

            INDE

            X

            httpwwwcmshhsgovMLNProducts

            27Official CMS Information for Medicare Fee-For-Service Providers 27

            Physicianpp 2 5-25

            Physician Assistant (PA)pp 2 5-25

            Psychologist Clinical See All Part B Providers

            Psychiatric HospitalSee Hospital

            Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

            Rural Health Clinic (RHC)p19See also All Rural Providers

            Rural Referral Center (RHC)p 19See also All Rural Providers

            Skilled Nursing Facility (SNF)pp 17 19 21

            Social Worker Clinicalp 7

            Sole Community Hospital p 19See All Rural Providers and Hospital

            Supplierpp 10-11 20

            Teacherpp 3 5 6

            X-Ray Facility Portablepp 7-8

            NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

            PROVIDER INDEX

            ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

            2828

            Official CMS Information for Medicare Fee-For-Service Providers

            httpwwwcmshhsgovMLNProducts

            SUBJ

            ECT

            INDE

            X

            Appealsp 10

            Articlesp 4

            AV Fistulap 20

            Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

            Bone Mass Measurementp 9

            Bookletsp 8

            Bookmarkspp 6 7 22

            Brochurespp 9-11

            Cancer p 9

            Certificate Of Medical Necessity (CMN)p 20

            Chiropracticp 12

            Claims Reviewp 8

            Clinical Laboratory Improvement Amendments (CLIA)p 9

            CMS Form 1500pp 13 20

            Diabetesp10

            Electronic Prescribing (E-Prescribing)pp 22 25

            Email Subscription Service p12

            Emergency Health Servicesp 17

            SUBJECT INDEXEnrollment Reportingp 13

            Evaluation And Management Services (EampM) p 2

            Fact Sheetspp 12-19 22-24

            Fee Schedulespp 12 16

            Fraud And Abusepp 16 21

            Glaucomap 10

            Guidespp 2 3 25

            Hospital Acquired Conditions (HAC)p 14

            Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

            Hospital Outpatient Prospective Payment System (OPPS)p 14

            ICD-9-CM Diagnosis Coding pp 20 23

            ICD-10-CM Procedure Codingp 23

            Immunizationpp 7 9

            Kidney Dialysis Transplant ESRDpp 2 16 20

            Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

            Manualsp 9

            Medicaidp 11

            httpwwwcmshhsgovMLNProducts

            29Official CMS Information for Medicare Fee-For-Service Providers

            SUBJECT INDEX

            29

            Medical Reviewp 11

            Medicarepp 21 25

            Medicare Learning Network (MLN)pp 4-6 18

            Medicare Remit Easy Print (MREP)p 10

            Medicare Secondary Payer (MSP)p 16

            Outpatient Code Editor (OCE)p 21

            Overpaymentsp 11

            Physical Examination (IPPE)pp 7 10

            Physician Fee Schedule (MPSF)p 16

            Physician Quality Reporting Initiative (PQRI)pp 21 23 24

            Podiatry Servicesp 16

            Power Mobility Devices (PMDs)p 9

            Practice Managementpp 2-3 7 11-12 16 21

            Present On Admission (POA)p 17

            Preventive Servicespp 2 6-11 21

            Privacyp 16

            Prospective Payment Systemspp 12-15 17 20

            Quick Reference Chartspp 7 22 24

            Rehabilitation Therapy p 17

            Remittance Advice (RA)p 3

            Rural Healthpp 5 7 18-19

            Smoking Cessationp 11

            SNF Consolidated Billingp 21

            Special Initiativespp 22-24

            Spell Of Illnessp 7

            Swing Bedp 19

            Telehealth Servicesp 19

            UB-04pp 14 21

            Undocumented Aliensp 17

            Web Addresses Resourcespp 5 25

            Web-Based Trainingpp 20 21

            Womenrsquos Healthp 21

            Official CMS Information for Medicare Fee-For-Service Providers

            November 2009

            ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

            R

            • INTRODUCTION13
            • TABLE OF CONTENTS
            • GUIDES
            • ARTICLES
            • EDUCATIONAL TOOLS
            • BOOKLETS
            • BROCHURES
            • FACT SHEETS13
            • TRAINING PRESENTATIONS13
            • WEB-BASED TRAINING13
            • SPECIAL INITIATIVES13
            • HELPFUL RESOURCES13
            • PROVIDER INDEX
            • SUBJECT INDEX

              httpwwwcmshhsgovMLNProducts

              5Official CMS Information for Medicare Fee-For-Service Providers

              CMS Website WheelThis website wheel is an informational resource that provides a variety of CMS Medicare-related websites The web addresses are listed by topic (ICN006212)

              Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

              Medicare Resident Practicing Physician and Other Health Care Professional Training Facilitator KitThis kit includes all the information and instructions necessary

              to prepare for and present a Medicare Resident Practicing Physician and Other Health Care Professional Training Program including instructions for facilitators customization guide a PowerPoint presentation with speaker notes pre- and post-assessments master assessment answer keys and evaluation tools The kit contains the following materials Medicare Physicians Guide A Resource for Residents Practicing Physicians and Other Health Care Professionals (print and CD Rom formats) Facilitatorrsquos Guide (print and CD Rom formats) and Medicare Resident Practicing Physicians and Other Health Care Professional Training An Introduction Video (October 2008) (ICN006351) Note This product is only available to Facilitators Trainers Educators and Physicians Formats Available Hard Copy onlySuggested For Educators Facilitators Physicians Trainers

              Medicare Billing Information for Rural Providers Suppliers and Physicians This product consists of charts that provide Medicare billing

              information for Rural Health Clinics Federally Qualified Health Centers Skilled Nursing Facilities Home Health Agencies Critical Access Hospitals and Swing Beds 36 pages (October 2008) (ICN006762) Formats Available Downloadable Hard Copy Suggested For Clinics Critical Access Hospitals Home Health Agencies NPP Physicians Skilled Nursing Facilities

              Medicare Learning Network (MLN)Guidance ToolThe Medicare Learning Network Guidance Tool is now available in CD ROM format and can be ordered through the Medicare Learning Network product ordering page This playable CD will streamline your search to find the most relevant and up-to-date links or URLs for national provider educational materials A tutorial will show you how to use the Guidance Tool to locate a new link (URL) refine your search as well as view download and order educational articles brochures fact sheets web-based training courses worksheets and videos Additionally the MLN Guidance Tool demonstrates how to navigate through sections of CMSrsquo Medicare Learning Network (January 2008) (ICN006843)Formats Available Hard Copy CD Rom Suggested For All Medicare Fee-For-Service Providers

              Educational Tools

              EDUCATIONAL TOOLS

              6

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

              outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

              Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

              these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

              Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

              way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

              Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

              Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

              MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

              is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

              EDUC

              ATIO

              NAL

              TOOL

              S

              httpwwwcmshhsgovMLNProducts

              7Official CMS Information for Medicare Fee-For-Service Providers

              Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

              SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

              Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

              For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

              Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

              that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

              Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

              Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

              For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

              Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

              used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

              EDUCATIONAL TOOLS

              8

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Booklets

              Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

              NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

              ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

              BOOK

              LETS

              httpwwwcmshhsgovMLNProducts

              9Official CMS Information for Medicare Fee-For-Service Providers

              BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

              Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

              Suggested For All Medicare Fee-For-Service Providers

              Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

              Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

              Suggested For All Medicare Fee-For-Service Providers

              Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

              (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

              Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

              (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

              The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

              BROCHURES

              10

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

              Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

              (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

              Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

              Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

              Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

              The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

              and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

              Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

              BROC

              HURE

              S

              httpwwwcmshhsgovMLNProducts

              11Official CMS Information for Medicare Fee-For-Service Providers

              The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

              health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

              The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

              covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

              Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

              Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

              What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

              BROCHURES

              ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

              12

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

              payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

              Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

              chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

              Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

              Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

              are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

              Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

              CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

              Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

              FACT

              SHE

              ETS

              httpwwwcmshhsgovMLNProducts

              13Official CMS Information for Medicare Fee-For-Service Providers

              Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

              reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

              Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

              for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

              Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

              are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

              Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

              a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

              Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

              documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

              Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

              (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

              FACT SHEETS

              14

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

              Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

              (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

              Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

              fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

              Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

              4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

              Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

              information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

              Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

              the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

              Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

              the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

              FACT

              SHE

              ETS

              httpwwwcmshhsgovMLNProducts

              15Official CMS Information for Medicare Fee-For-Service Providers

              Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

              and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

              Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

              4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

              Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

              9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

              Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

              System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

              Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

              Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

              Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

              8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

              FACT SHEETS

              16

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

              Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

              on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

              Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

              Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

              Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

              Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

              Downloadable only Suggested For NPP Physicians

              Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

              settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

              Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

              separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

              ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

              FACT

              SHE

              ETS

              httpwwwcmshhsgovMLNProducts

              17Official CMS Information for Medicare Fee-For-Service Providers

              Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

              of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

              Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

              of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

              Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

              as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

              Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

              FACT SHEETS

              Official CMS Information for Medicare Fee-For-Service Providers

              18

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

              Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

              and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

              Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

              Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

              Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

              Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

              payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

              Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

              Downloadable only Suggested For Hospitals

              Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

              Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

              FACT

              SHE

              ETS

              httpwwwcmshhsgovMLNProducts

              19Official CMS Information for Medicare Fee-For-Service Providers

              Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

              Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

              Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

              Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

              Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

              or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

              Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

              4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

              Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

              sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

              FACT SHEETS

              20

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Training Presentations

              Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

              Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

              CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

              Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

              Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

              WEB

              -BAS

              ED T

              RAIN

              ING

              TRAI

              NING

              PRE

              SENT

              ATIO

              NS

              Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

              httpwwwcmshhsgovMLNProducts

              21Official CMS Information for Medicare Fee-For-Service Providers

              Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

              Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

              Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

              Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

              Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

              Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

              Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

              World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

              WEB-BASED TRAINING

              22

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

              2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

              2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

              2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

              ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

              ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

              ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

              Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

              ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

              SPEC

              IAL

              INIT

              IATI

              VES

              httpwwwcmshhsgovMLNProducts

              23Official CMS Information for Medicare Fee-For-Service Providers

              General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

              Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

              Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

              2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

              2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

              PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

              2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

              2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

              2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

              SPECIAL INITIATIVES

              24

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

              2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

              2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

              2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

              PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

              2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

              SPEC

              IAL

              INIT

              IATI

              VES

              ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

              httpwwwcmshhsgovMLNProducts

              25Official CMS Information for Medicare Fee-For-Service Providers

              Helpful Resources

              Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

              Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

              Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

              Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

              ICD-10httpwwwcmshhsgovICD10

              Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

              Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

              Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

              Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

              Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

              Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

              Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

              HELPFUL RESOURCES

              26

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts26

              All Medicare Fee-For-Service Providerspp 2-12 16-23 25

              All Institutional Providerspp 9 14 20 21

              All Part B Providerspp 11 13

              All Rural Providerspp 5 7 18 19

              Ambulance Supplierpp 10-12 17 20

              Ambulatory Surgical Center (ASC)pp 9 12

              Chiropractorp 12

              Clinics Group Practicespp 5 7-9 13

              Community Mental Health Centerp 14See All Institutional Providers

              Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

              Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

              Diagnostic Testing Facility Independent (IDTF)pp 7-9

              Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

              End Stage Renal Disease Facility (ESRD)pp 9 16 20

              Facilitatorpp 3 5 6

              Federally Qualified Health Center (FQHC)pp 18-19

              PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

              Hospicep 14

              Hospitalpp 3 7-9 12-15 16-20

              Indian Health Service Facility (IHS)pp 6 14 17

              Inpatient Rehabilitation Facilitypp 9 15

              Laboratory Independent Clinical (ICL)pp 7-9

              Long Term Care Hospital (LTCH)p 15

              Mammography Centerpp 7-8

              Medical Billers Coderspp 17 22 23

              Medicare Dependent Hospitalp 18

              NPP Non-Physician Practitionerpp 2 5-25

              Nurse Anesthetist (CRNA)pp 2 5-25

              Nurse Midwife (CNM)pp 2 5-25

              Nurse Practitioner (NP)pp 2 5-25

              Nurse Specialist (CNS)pp 2 5-25

              Pharmacy PharmacistSee Supplier

              Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

              PROV

              IDER

              INDE

              X

              httpwwwcmshhsgovMLNProducts

              27Official CMS Information for Medicare Fee-For-Service Providers 27

              Physicianpp 2 5-25

              Physician Assistant (PA)pp 2 5-25

              Psychologist Clinical See All Part B Providers

              Psychiatric HospitalSee Hospital

              Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

              Rural Health Clinic (RHC)p19See also All Rural Providers

              Rural Referral Center (RHC)p 19See also All Rural Providers

              Skilled Nursing Facility (SNF)pp 17 19 21

              Social Worker Clinicalp 7

              Sole Community Hospital p 19See All Rural Providers and Hospital

              Supplierpp 10-11 20

              Teacherpp 3 5 6

              X-Ray Facility Portablepp 7-8

              NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

              PROVIDER INDEX

              ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

              2828

              Official CMS Information for Medicare Fee-For-Service Providers

              httpwwwcmshhsgovMLNProducts

              SUBJ

              ECT

              INDE

              X

              Appealsp 10

              Articlesp 4

              AV Fistulap 20

              Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

              Bone Mass Measurementp 9

              Bookletsp 8

              Bookmarkspp 6 7 22

              Brochurespp 9-11

              Cancer p 9

              Certificate Of Medical Necessity (CMN)p 20

              Chiropracticp 12

              Claims Reviewp 8

              Clinical Laboratory Improvement Amendments (CLIA)p 9

              CMS Form 1500pp 13 20

              Diabetesp10

              Electronic Prescribing (E-Prescribing)pp 22 25

              Email Subscription Service p12

              Emergency Health Servicesp 17

              SUBJECT INDEXEnrollment Reportingp 13

              Evaluation And Management Services (EampM) p 2

              Fact Sheetspp 12-19 22-24

              Fee Schedulespp 12 16

              Fraud And Abusepp 16 21

              Glaucomap 10

              Guidespp 2 3 25

              Hospital Acquired Conditions (HAC)p 14

              Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

              Hospital Outpatient Prospective Payment System (OPPS)p 14

              ICD-9-CM Diagnosis Coding pp 20 23

              ICD-10-CM Procedure Codingp 23

              Immunizationpp 7 9

              Kidney Dialysis Transplant ESRDpp 2 16 20

              Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

              Manualsp 9

              Medicaidp 11

              httpwwwcmshhsgovMLNProducts

              29Official CMS Information for Medicare Fee-For-Service Providers

              SUBJECT INDEX

              29

              Medical Reviewp 11

              Medicarepp 21 25

              Medicare Learning Network (MLN)pp 4-6 18

              Medicare Remit Easy Print (MREP)p 10

              Medicare Secondary Payer (MSP)p 16

              Outpatient Code Editor (OCE)p 21

              Overpaymentsp 11

              Physical Examination (IPPE)pp 7 10

              Physician Fee Schedule (MPSF)p 16

              Physician Quality Reporting Initiative (PQRI)pp 21 23 24

              Podiatry Servicesp 16

              Power Mobility Devices (PMDs)p 9

              Practice Managementpp 2-3 7 11-12 16 21

              Present On Admission (POA)p 17

              Preventive Servicespp 2 6-11 21

              Privacyp 16

              Prospective Payment Systemspp 12-15 17 20

              Quick Reference Chartspp 7 22 24

              Rehabilitation Therapy p 17

              Remittance Advice (RA)p 3

              Rural Healthpp 5 7 18-19

              Smoking Cessationp 11

              SNF Consolidated Billingp 21

              Special Initiativespp 22-24

              Spell Of Illnessp 7

              Swing Bedp 19

              Telehealth Servicesp 19

              UB-04pp 14 21

              Undocumented Aliensp 17

              Web Addresses Resourcespp 5 25

              Web-Based Trainingpp 20 21

              Womenrsquos Healthp 21

              Official CMS Information for Medicare Fee-For-Service Providers

              November 2009

              ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

              R

              • INTRODUCTION13
              • TABLE OF CONTENTS
              • GUIDES
              • ARTICLES
              • EDUCATIONAL TOOLS
              • BOOKLETS
              • BROCHURES
              • FACT SHEETS13
              • TRAINING PRESENTATIONS13
              • WEB-BASED TRAINING13
              • SPECIAL INITIATIVES13
              • HELPFUL RESOURCES13
              • PROVIDER INDEX
              • SUBJECT INDEX

                6

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Educational ToolsMedicare Learning Network (MLN) BookmarkThe MLN bookmark lists the topics covered by the educational products and services of the MLN the various product types available to the learner and the web address for the MLN This product is appropriate for distribution at health care professional conferences provider

                outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (February 2008) (ICN006960) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

                Medicare Preventive Services BookmarkThis bookmark lists the preventive services and screenings covered by Medicare and provides a message that encourages health care professionals to talk with their Medicare patients about these preventive services and encourage them to take advantage of

                these potentially life saving benefits This product is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of provider supplier events 2-sided bookmark (January 2007) (ICN006766) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

                Medicare Fee-For-Service Provider Supplier Web Pages Bookmark This bookmark is for all Medicare Fee-For-Service (FFS) providers and suppliers and their staff to use as a one-stop resource for the Medicare FFS provider and supplier web pages available on the CMS website This bookmark includes a handy

                way to access and peruse the Medicare FFS web pages and stay abreast of policy and operational updates to FFS initiatives 2-sided bookmark (November 2008) (ICN901184) Formats Available Hard Copy OnlySuggested For All Medicare Fee-For-Service Providers

                Medicare Resident Practicing Physician and Other Health Care Professional Training Program BookmarkThis bookmark provides information about the Medicare Resident Practicing Physician and Other Health Care Professional Training Program 2-sided bookmark (November 2008) (ICN006916)

                Formats Available Hard Copy Only Suggested For Educators Facilitators Physicians Trainers

                MLN Bookmark for Indian Health Care (IHS) ProfessionalsThe MLN Bookmark for Indian Health Care Professionals lists the topics covered by the educational products and services of the MLN the various product types available for Indian Health providers and their staff as well as the web address for the MLN This product

                is appropriate for distribution at health care professional conferences provider outreach and education activities and other appropriate types of providersupplier events where Indian health care professionals will meet (February 2008) (ICN006954) Formats Available Downloadable Hard Copy Suggested For IHS Providers

                EDUC

                ATIO

                NAL

                TOOL

                S

                httpwwwcmshhsgovMLNProducts

                7Official CMS Information for Medicare Fee-For-Service Providers

                Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

                SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

                Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

                For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

                Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

                that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

                Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

                Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

                For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

                Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

                used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

                EDUCATIONAL TOOLS

                8

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Booklets

                Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

                NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

                ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

                BOOK

                LETS

                httpwwwcmshhsgovMLNProducts

                9Official CMS Information for Medicare Fee-For-Service Providers

                BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

                Suggested For All Medicare Fee-For-Service Providers

                Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

                Suggested For All Medicare Fee-For-Service Providers

                Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

                (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

                Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

                (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

                The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

                BROCHURES

                10

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

                (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

                Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

                and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

                Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

                BROC

                HURE

                S

                httpwwwcmshhsgovMLNProducts

                11Official CMS Information for Medicare Fee-For-Service Providers

                The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

                health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

                The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

                covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

                Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

                What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                BROCHURES

                ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

                12

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

                payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

                Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

                chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

                Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

                Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

                are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

                Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

                CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

                Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                FACT

                SHE

                ETS

                httpwwwcmshhsgovMLNProducts

                13Official CMS Information for Medicare Fee-For-Service Providers

                Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                FACT SHEETS

                14

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                FACT

                SHE

                ETS

                httpwwwcmshhsgovMLNProducts

                15Official CMS Information for Medicare Fee-For-Service Providers

                Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                FACT SHEETS

                16

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                Downloadable only Suggested For NPP Physicians

                Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                FACT

                SHE

                ETS

                httpwwwcmshhsgovMLNProducts

                17Official CMS Information for Medicare Fee-For-Service Providers

                Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                FACT SHEETS

                Official CMS Information for Medicare Fee-For-Service Providers

                18

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                Downloadable only Suggested For Hospitals

                Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                FACT

                SHE

                ETS

                httpwwwcmshhsgovMLNProducts

                19Official CMS Information for Medicare Fee-For-Service Providers

                Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                FACT SHEETS

                20

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Training Presentations

                Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                WEB

                -BAS

                ED T

                RAIN

                ING

                TRAI

                NING

                PRE

                SENT

                ATIO

                NS

                Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                httpwwwcmshhsgovMLNProducts

                21Official CMS Information for Medicare Fee-For-Service Providers

                Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                WEB-BASED TRAINING

                22

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                SPEC

                IAL

                INIT

                IATI

                VES

                httpwwwcmshhsgovMLNProducts

                23Official CMS Information for Medicare Fee-For-Service Providers

                General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                SPECIAL INITIATIVES

                24

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                SPEC

                IAL

                INIT

                IATI

                VES

                ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                httpwwwcmshhsgovMLNProducts

                25Official CMS Information for Medicare Fee-For-Service Providers

                Helpful Resources

                Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                ICD-10httpwwwcmshhsgovICD10

                Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                HELPFUL RESOURCES

                26

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts26

                All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                All Institutional Providerspp 9 14 20 21

                All Part B Providerspp 11 13

                All Rural Providerspp 5 7 18 19

                Ambulance Supplierpp 10-12 17 20

                Ambulatory Surgical Center (ASC)pp 9 12

                Chiropractorp 12

                Clinics Group Practicespp 5 7-9 13

                Community Mental Health Centerp 14See All Institutional Providers

                Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                Diagnostic Testing Facility Independent (IDTF)pp 7-9

                Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                End Stage Renal Disease Facility (ESRD)pp 9 16 20

                Facilitatorpp 3 5 6

                Federally Qualified Health Center (FQHC)pp 18-19

                PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                Hospicep 14

                Hospitalpp 3 7-9 12-15 16-20

                Indian Health Service Facility (IHS)pp 6 14 17

                Inpatient Rehabilitation Facilitypp 9 15

                Laboratory Independent Clinical (ICL)pp 7-9

                Long Term Care Hospital (LTCH)p 15

                Mammography Centerpp 7-8

                Medical Billers Coderspp 17 22 23

                Medicare Dependent Hospitalp 18

                NPP Non-Physician Practitionerpp 2 5-25

                Nurse Anesthetist (CRNA)pp 2 5-25

                Nurse Midwife (CNM)pp 2 5-25

                Nurse Practitioner (NP)pp 2 5-25

                Nurse Specialist (CNS)pp 2 5-25

                Pharmacy PharmacistSee Supplier

                Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                PROV

                IDER

                INDE

                X

                httpwwwcmshhsgovMLNProducts

                27Official CMS Information for Medicare Fee-For-Service Providers 27

                Physicianpp 2 5-25

                Physician Assistant (PA)pp 2 5-25

                Psychologist Clinical See All Part B Providers

                Psychiatric HospitalSee Hospital

                Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                Rural Health Clinic (RHC)p19See also All Rural Providers

                Rural Referral Center (RHC)p 19See also All Rural Providers

                Skilled Nursing Facility (SNF)pp 17 19 21

                Social Worker Clinicalp 7

                Sole Community Hospital p 19See All Rural Providers and Hospital

                Supplierpp 10-11 20

                Teacherpp 3 5 6

                X-Ray Facility Portablepp 7-8

                NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                PROVIDER INDEX

                ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                2828

                Official CMS Information for Medicare Fee-For-Service Providers

                httpwwwcmshhsgovMLNProducts

                SUBJ

                ECT

                INDE

                X

                Appealsp 10

                Articlesp 4

                AV Fistulap 20

                Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                Bone Mass Measurementp 9

                Bookletsp 8

                Bookmarkspp 6 7 22

                Brochurespp 9-11

                Cancer p 9

                Certificate Of Medical Necessity (CMN)p 20

                Chiropracticp 12

                Claims Reviewp 8

                Clinical Laboratory Improvement Amendments (CLIA)p 9

                CMS Form 1500pp 13 20

                Diabetesp10

                Electronic Prescribing (E-Prescribing)pp 22 25

                Email Subscription Service p12

                Emergency Health Servicesp 17

                SUBJECT INDEXEnrollment Reportingp 13

                Evaluation And Management Services (EampM) p 2

                Fact Sheetspp 12-19 22-24

                Fee Schedulespp 12 16

                Fraud And Abusepp 16 21

                Glaucomap 10

                Guidespp 2 3 25

                Hospital Acquired Conditions (HAC)p 14

                Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                Hospital Outpatient Prospective Payment System (OPPS)p 14

                ICD-9-CM Diagnosis Coding pp 20 23

                ICD-10-CM Procedure Codingp 23

                Immunizationpp 7 9

                Kidney Dialysis Transplant ESRDpp 2 16 20

                Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                Manualsp 9

                Medicaidp 11

                httpwwwcmshhsgovMLNProducts

                29Official CMS Information for Medicare Fee-For-Service Providers

                SUBJECT INDEX

                29

                Medical Reviewp 11

                Medicarepp 21 25

                Medicare Learning Network (MLN)pp 4-6 18

                Medicare Remit Easy Print (MREP)p 10

                Medicare Secondary Payer (MSP)p 16

                Outpatient Code Editor (OCE)p 21

                Overpaymentsp 11

                Physical Examination (IPPE)pp 7 10

                Physician Fee Schedule (MPSF)p 16

                Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                Podiatry Servicesp 16

                Power Mobility Devices (PMDs)p 9

                Practice Managementpp 2-3 7 11-12 16 21

                Present On Admission (POA)p 17

                Preventive Servicespp 2 6-11 21

                Privacyp 16

                Prospective Payment Systemspp 12-15 17 20

                Quick Reference Chartspp 7 22 24

                Rehabilitation Therapy p 17

                Remittance Advice (RA)p 3

                Rural Healthpp 5 7 18-19

                Smoking Cessationp 11

                SNF Consolidated Billingp 21

                Special Initiativespp 22-24

                Spell Of Illnessp 7

                Swing Bedp 19

                Telehealth Servicesp 19

                UB-04pp 14 21

                Undocumented Aliensp 17

                Web Addresses Resourcespp 5 25

                Web-Based Trainingpp 20 21

                Womenrsquos Healthp 21

                Official CMS Information for Medicare Fee-For-Service Providers

                November 2009

                ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                R

                • INTRODUCTION13
                • TABLE OF CONTENTS
                • GUIDES
                • ARTICLES
                • EDUCATIONAL TOOLS
                • BOOKLETS
                • BROCHURES
                • FACT SHEETS13
                • TRAINING PRESENTATIONS13
                • WEB-BASED TRAINING13
                • SPECIAL INITIATIVES13
                • HELPFUL RESOURCES13
                • PROVIDER INDEX
                • SUBJECT INDEX

                  httpwwwcmshhsgovMLNProducts

                  7Official CMS Information for Medicare Fee-For-Service Providers

                  Skilled Nursing Facility (SNF) Spell of Illness Quick Reference ChartThis reference chart provides Medicare claims processing information related to

                  SNF spells of illness 1 page (January 2009) (ICN006846) Formats Available Downloadable only Suggested For Clinical Social Workers Skilled Nursing Facilities

                  Quick Reference Information Medicare Preventive ServicesThis laminated reference chart gives Medicare Fee-

                  For-Service physicians providers suppliers and other health care professionals a quick reference to Medicarersquos preventive services (January 2009) (ICN006559)Formats Available Downloadable Hard Copy Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities

                  Steps To Accessing CMS Enterprise Applications for Provider OrganizationsA fact sheet chart for provider organizations

                  that outlines how to access CMS enterprise applications CMS enterprise applications are those hosted and managed by CMS and do not include Medicare Fiscal Intermediaries (FIs) Carriers or Medicare Administrative Contractors (MACs) Internet Applications 2 pages (August 2009) (ICN902463) Formats Available Downloadable onlySuggested For All Medicare Fee-For-Service Providers

                  Rural Health BookmarkThis bookmark offers Medicare providers suppliers and physicians information about rural educational resources 2-sided bookmark (November 2008) (ICN006917) Formats Available Downloadable Hard CopySuggested For Rural Health Providers

                  Quick Reference Information Medicare Part B Immunization BillingThis laminated reference chart gives Medicare Fee-

                  For-Service physicians providers suppliers and other health care professionals quick information to assist with filing claims for influenza vaccine pneumococcal vaccine and Hepatitis B Virus (HBV) vaccine and their administration (March 2009) (ICN006799)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers

                  Quick Reference Information The ABCs Of Providing The Initial Preventive Physical Examination (IPPE)This laminated chart can be

                  used by Medicare Fee-For-Service physicians and qualified Non-Physicians practitioners as a guide when providing the Initial Preventive Physical Examination (IPPE) (also known as the ldquoWelcome to Medicarerdquo Physical Exam or the ldquoWelcome to Medicarerdquo Visit) This chart identifies the components and elements of the IPPE and provides eligibility requirements procedure codes to use when filing claims FAQs suggestions for preparing patients for the IPPE and lists references for additional information (January 2009) (ICN006904)Formats Available Downloadable Hard Copy Suggested For NPP Physicians

                  EDUCATIONAL TOOLS

                  8

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Booklets

                  Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

                  NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

                  ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

                  BOOK

                  LETS

                  httpwwwcmshhsgovMLNProducts

                  9Official CMS Information for Medicare Fee-For-Service Providers

                  BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                  Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

                  Suggested For All Medicare Fee-For-Service Providers

                  Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                  Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

                  Suggested For All Medicare Fee-For-Service Providers

                  Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

                  (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

                  Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

                  (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

                  The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

                  BROCHURES

                  10

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                  Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

                  (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                  Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

                  Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                  Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                  The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

                  and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

                  Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

                  BROC

                  HURE

                  S

                  httpwwwcmshhsgovMLNProducts

                  11Official CMS Information for Medicare Fee-For-Service Providers

                  The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

                  health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

                  The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

                  covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                  Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

                  Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

                  What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                  BROCHURES

                  ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

                  12

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

                  payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

                  Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

                  chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

                  Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

                  Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

                  are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

                  Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

                  CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

                  Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                  FACT

                  SHE

                  ETS

                  httpwwwcmshhsgovMLNProducts

                  13Official CMS Information for Medicare Fee-For-Service Providers

                  Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                  reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                  Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                  for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                  Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                  are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                  Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                  a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                  Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                  documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                  Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                  (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                  FACT SHEETS

                  14

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                  Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                  (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                  Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                  fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                  Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                  4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                  Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                  information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                  Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                  the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                  Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                  the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                  FACT

                  SHE

                  ETS

                  httpwwwcmshhsgovMLNProducts

                  15Official CMS Information for Medicare Fee-For-Service Providers

                  Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                  and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                  4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                  9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                  System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                  Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                  Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                  8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                  FACT SHEETS

                  16

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                  Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                  on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                  Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                  Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                  Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                  Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                  Downloadable only Suggested For NPP Physicians

                  Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                  settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                  Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                  separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                  ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                  FACT

                  SHE

                  ETS

                  httpwwwcmshhsgovMLNProducts

                  17Official CMS Information for Medicare Fee-For-Service Providers

                  Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                  of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                  Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                  of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                  Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                  as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                  Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                  FACT SHEETS

                  Official CMS Information for Medicare Fee-For-Service Providers

                  18

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                  Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                  and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                  Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                  Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                  Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                  Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                  payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                  Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                  Downloadable only Suggested For Hospitals

                  Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                  Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                  FACT

                  SHE

                  ETS

                  httpwwwcmshhsgovMLNProducts

                  19Official CMS Information for Medicare Fee-For-Service Providers

                  Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                  Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                  Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                  Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                  Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                  or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                  Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                  4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                  Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                  sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                  FACT SHEETS

                  20

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Training Presentations

                  Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                  Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                  CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                  Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                  Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                  WEB

                  -BAS

                  ED T

                  RAIN

                  ING

                  TRAI

                  NING

                  PRE

                  SENT

                  ATIO

                  NS

                  Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                  httpwwwcmshhsgovMLNProducts

                  21Official CMS Information for Medicare Fee-For-Service Providers

                  Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                  Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                  Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                  Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                  Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                  Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                  Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                  World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                  WEB-BASED TRAINING

                  22

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                  2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                  2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                  2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                  ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                  ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                  ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                  Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                  ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                  SPEC

                  IAL

                  INIT

                  IATI

                  VES

                  httpwwwcmshhsgovMLNProducts

                  23Official CMS Information for Medicare Fee-For-Service Providers

                  General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                  Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                  Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                  2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                  2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                  PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                  2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                  2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                  2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                  SPECIAL INITIATIVES

                  24

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                  2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                  2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                  2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                  PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                  2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                  SPEC

                  IAL

                  INIT

                  IATI

                  VES

                  ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                  httpwwwcmshhsgovMLNProducts

                  25Official CMS Information for Medicare Fee-For-Service Providers

                  Helpful Resources

                  Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                  Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                  Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                  Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                  ICD-10httpwwwcmshhsgovICD10

                  Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                  Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                  Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                  Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                  Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                  Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                  Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                  HELPFUL RESOURCES

                  26

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts26

                  All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                  All Institutional Providerspp 9 14 20 21

                  All Part B Providerspp 11 13

                  All Rural Providerspp 5 7 18 19

                  Ambulance Supplierpp 10-12 17 20

                  Ambulatory Surgical Center (ASC)pp 9 12

                  Chiropractorp 12

                  Clinics Group Practicespp 5 7-9 13

                  Community Mental Health Centerp 14See All Institutional Providers

                  Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                  Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                  Diagnostic Testing Facility Independent (IDTF)pp 7-9

                  Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                  End Stage Renal Disease Facility (ESRD)pp 9 16 20

                  Facilitatorpp 3 5 6

                  Federally Qualified Health Center (FQHC)pp 18-19

                  PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                  Hospicep 14

                  Hospitalpp 3 7-9 12-15 16-20

                  Indian Health Service Facility (IHS)pp 6 14 17

                  Inpatient Rehabilitation Facilitypp 9 15

                  Laboratory Independent Clinical (ICL)pp 7-9

                  Long Term Care Hospital (LTCH)p 15

                  Mammography Centerpp 7-8

                  Medical Billers Coderspp 17 22 23

                  Medicare Dependent Hospitalp 18

                  NPP Non-Physician Practitionerpp 2 5-25

                  Nurse Anesthetist (CRNA)pp 2 5-25

                  Nurse Midwife (CNM)pp 2 5-25

                  Nurse Practitioner (NP)pp 2 5-25

                  Nurse Specialist (CNS)pp 2 5-25

                  Pharmacy PharmacistSee Supplier

                  Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                  PROV

                  IDER

                  INDE

                  X

                  httpwwwcmshhsgovMLNProducts

                  27Official CMS Information for Medicare Fee-For-Service Providers 27

                  Physicianpp 2 5-25

                  Physician Assistant (PA)pp 2 5-25

                  Psychologist Clinical See All Part B Providers

                  Psychiatric HospitalSee Hospital

                  Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                  Rural Health Clinic (RHC)p19See also All Rural Providers

                  Rural Referral Center (RHC)p 19See also All Rural Providers

                  Skilled Nursing Facility (SNF)pp 17 19 21

                  Social Worker Clinicalp 7

                  Sole Community Hospital p 19See All Rural Providers and Hospital

                  Supplierpp 10-11 20

                  Teacherpp 3 5 6

                  X-Ray Facility Portablepp 7-8

                  NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                  PROVIDER INDEX

                  ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                  2828

                  Official CMS Information for Medicare Fee-For-Service Providers

                  httpwwwcmshhsgovMLNProducts

                  SUBJ

                  ECT

                  INDE

                  X

                  Appealsp 10

                  Articlesp 4

                  AV Fistulap 20

                  Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                  Bone Mass Measurementp 9

                  Bookletsp 8

                  Bookmarkspp 6 7 22

                  Brochurespp 9-11

                  Cancer p 9

                  Certificate Of Medical Necessity (CMN)p 20

                  Chiropracticp 12

                  Claims Reviewp 8

                  Clinical Laboratory Improvement Amendments (CLIA)p 9

                  CMS Form 1500pp 13 20

                  Diabetesp10

                  Electronic Prescribing (E-Prescribing)pp 22 25

                  Email Subscription Service p12

                  Emergency Health Servicesp 17

                  SUBJECT INDEXEnrollment Reportingp 13

                  Evaluation And Management Services (EampM) p 2

                  Fact Sheetspp 12-19 22-24

                  Fee Schedulespp 12 16

                  Fraud And Abusepp 16 21

                  Glaucomap 10

                  Guidespp 2 3 25

                  Hospital Acquired Conditions (HAC)p 14

                  Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                  Hospital Outpatient Prospective Payment System (OPPS)p 14

                  ICD-9-CM Diagnosis Coding pp 20 23

                  ICD-10-CM Procedure Codingp 23

                  Immunizationpp 7 9

                  Kidney Dialysis Transplant ESRDpp 2 16 20

                  Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                  Manualsp 9

                  Medicaidp 11

                  httpwwwcmshhsgovMLNProducts

                  29Official CMS Information for Medicare Fee-For-Service Providers

                  SUBJECT INDEX

                  29

                  Medical Reviewp 11

                  Medicarepp 21 25

                  Medicare Learning Network (MLN)pp 4-6 18

                  Medicare Remit Easy Print (MREP)p 10

                  Medicare Secondary Payer (MSP)p 16

                  Outpatient Code Editor (OCE)p 21

                  Overpaymentsp 11

                  Physical Examination (IPPE)pp 7 10

                  Physician Fee Schedule (MPSF)p 16

                  Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                  Podiatry Servicesp 16

                  Power Mobility Devices (PMDs)p 9

                  Practice Managementpp 2-3 7 11-12 16 21

                  Present On Admission (POA)p 17

                  Preventive Servicespp 2 6-11 21

                  Privacyp 16

                  Prospective Payment Systemspp 12-15 17 20

                  Quick Reference Chartspp 7 22 24

                  Rehabilitation Therapy p 17

                  Remittance Advice (RA)p 3

                  Rural Healthpp 5 7 18-19

                  Smoking Cessationp 11

                  SNF Consolidated Billingp 21

                  Special Initiativespp 22-24

                  Spell Of Illnessp 7

                  Swing Bedp 19

                  Telehealth Servicesp 19

                  UB-04pp 14 21

                  Undocumented Aliensp 17

                  Web Addresses Resourcespp 5 25

                  Web-Based Trainingpp 20 21

                  Womenrsquos Healthp 21

                  Official CMS Information for Medicare Fee-For-Service Providers

                  November 2009

                  ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                  R

                  • INTRODUCTION13
                  • TABLE OF CONTENTS
                  • GUIDES
                  • ARTICLES
                  • EDUCATIONAL TOOLS
                  • BOOKLETS
                  • BROCHURES
                  • FACT SHEETS13
                  • TRAINING PRESENTATIONS13
                  • WEB-BASED TRAINING13
                  • SPECIAL INITIATIVES13
                  • HELPFUL RESOURCES13
                  • PROVIDER INDEX
                  • SUBJECT INDEX

                    8

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Booklets

                    Determining A Medicare Beneficiaryrsquos Eligibility for Medicare Preventive ServicesThis booklet provides information on interpreting the Medicare beneficiary preventive services ldquonext eligible daterdquo data and is intended to supplement the educational materials already available for the HIQA HIQH HUQA ELGA ELGB and ELGH eligibility inquiry screens used to access Common Working File (CWF) records 22 pages (December 2007) (ICN006766) Formats Available Downloadable only Suggested For Clinics Diagnostic Testing Facilities Hospitals Laboratories Mammography Centers NPP Physicians Portable X-ray Facilities Medicare Claim Review Programs MR

                    NCCI Edits MUEs CERT and RACThis booklet explains the different CMS claims review programs and assists providers in reducing payment errors in particular coverage and coding errors 14 pages (October 2008) (ICN006973) Formats Available Downloadable Hard Copy Suggested For All Medicare Fee-For-Service Providers

                    ldquoI like being able to see the pictures and descriptions of each item in the catalog as well as the various versions available for the productsrdquo ndash Provider

                    BOOK

                    LETS

                    httpwwwcmshhsgovMLNProducts

                    9Official CMS Information for Medicare Fee-For-Service Providers

                    BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                    Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

                    Suggested For All Medicare Fee-For-Service Providers

                    Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                    Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

                    Suggested For All Medicare Fee-For-Service Providers

                    Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

                    (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

                    Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

                    (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

                    The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

                    BROCHURES

                    10

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                    Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

                    (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                    Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

                    Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                    Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                    The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

                    and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

                    Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

                    BROC

                    HURE

                    S

                    httpwwwcmshhsgovMLNProducts

                    11Official CMS Information for Medicare Fee-For-Service Providers

                    The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

                    health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

                    The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

                    covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                    Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

                    Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

                    What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                    BROCHURES

                    ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

                    12

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

                    payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

                    Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

                    chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

                    Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

                    Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

                    are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

                    Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

                    CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

                    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                    FACT

                    SHE

                    ETS

                    httpwwwcmshhsgovMLNProducts

                    13Official CMS Information for Medicare Fee-For-Service Providers

                    Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                    reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                    Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                    for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                    Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                    are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                    Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                    a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                    Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                    documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                    Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                    (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                    FACT SHEETS

                    14

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                    Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                    (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                    Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                    fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                    Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                    4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                    Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                    information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                    Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                    the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                    Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                    the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                    FACT

                    SHE

                    ETS

                    httpwwwcmshhsgovMLNProducts

                    15Official CMS Information for Medicare Fee-For-Service Providers

                    Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                    and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                    Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                    4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                    Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                    9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                    Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                    System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                    Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                    Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                    Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                    8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                    FACT SHEETS

                    16

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                    Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                    on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                    Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                    Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                    Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                    Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                    Downloadable only Suggested For NPP Physicians

                    Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                    settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                    Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                    separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                    ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                    FACT

                    SHE

                    ETS

                    httpwwwcmshhsgovMLNProducts

                    17Official CMS Information for Medicare Fee-For-Service Providers

                    Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                    of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                    Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                    of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                    Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                    as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                    Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                    FACT SHEETS

                    Official CMS Information for Medicare Fee-For-Service Providers

                    18

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                    Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                    and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                    Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                    Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                    Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                    Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                    payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                    Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                    Downloadable only Suggested For Hospitals

                    Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                    Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                    FACT

                    SHE

                    ETS

                    httpwwwcmshhsgovMLNProducts

                    19Official CMS Information for Medicare Fee-For-Service Providers

                    Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                    Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                    Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                    Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                    Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                    or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                    Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                    4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                    Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                    sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                    FACT SHEETS

                    20

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Training Presentations

                    Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                    Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                    CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                    Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                    Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                    WEB

                    -BAS

                    ED T

                    RAIN

                    ING

                    TRAI

                    NING

                    PRE

                    SENT

                    ATIO

                    NS

                    Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                    httpwwwcmshhsgovMLNProducts

                    21Official CMS Information for Medicare Fee-For-Service Providers

                    Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                    Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                    Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                    Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                    Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                    Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                    Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                    World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                    WEB-BASED TRAINING

                    22

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                    2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                    2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                    2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                    ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                    ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                    ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                    Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                    ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                    SPEC

                    IAL

                    INIT

                    IATI

                    VES

                    httpwwwcmshhsgovMLNProducts

                    23Official CMS Information for Medicare Fee-For-Service Providers

                    General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                    Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                    Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                    2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                    2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                    PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                    2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                    2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                    2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                    SPECIAL INITIATIVES

                    24

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                    2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                    2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                    2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                    PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                    2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                    SPEC

                    IAL

                    INIT

                    IATI

                    VES

                    ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                    httpwwwcmshhsgovMLNProducts

                    25Official CMS Information for Medicare Fee-For-Service Providers

                    Helpful Resources

                    Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                    Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                    Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                    Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                    ICD-10httpwwwcmshhsgovICD10

                    Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                    Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                    Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                    Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                    Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                    Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                    Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                    HELPFUL RESOURCES

                    26

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts26

                    All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                    All Institutional Providerspp 9 14 20 21

                    All Part B Providerspp 11 13

                    All Rural Providerspp 5 7 18 19

                    Ambulance Supplierpp 10-12 17 20

                    Ambulatory Surgical Center (ASC)pp 9 12

                    Chiropractorp 12

                    Clinics Group Practicespp 5 7-9 13

                    Community Mental Health Centerp 14See All Institutional Providers

                    Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                    Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                    Diagnostic Testing Facility Independent (IDTF)pp 7-9

                    Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                    End Stage Renal Disease Facility (ESRD)pp 9 16 20

                    Facilitatorpp 3 5 6

                    Federally Qualified Health Center (FQHC)pp 18-19

                    PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                    Hospicep 14

                    Hospitalpp 3 7-9 12-15 16-20

                    Indian Health Service Facility (IHS)pp 6 14 17

                    Inpatient Rehabilitation Facilitypp 9 15

                    Laboratory Independent Clinical (ICL)pp 7-9

                    Long Term Care Hospital (LTCH)p 15

                    Mammography Centerpp 7-8

                    Medical Billers Coderspp 17 22 23

                    Medicare Dependent Hospitalp 18

                    NPP Non-Physician Practitionerpp 2 5-25

                    Nurse Anesthetist (CRNA)pp 2 5-25

                    Nurse Midwife (CNM)pp 2 5-25

                    Nurse Practitioner (NP)pp 2 5-25

                    Nurse Specialist (CNS)pp 2 5-25

                    Pharmacy PharmacistSee Supplier

                    Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                    PROV

                    IDER

                    INDE

                    X

                    httpwwwcmshhsgovMLNProducts

                    27Official CMS Information for Medicare Fee-For-Service Providers 27

                    Physicianpp 2 5-25

                    Physician Assistant (PA)pp 2 5-25

                    Psychologist Clinical See All Part B Providers

                    Psychiatric HospitalSee Hospital

                    Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                    Rural Health Clinic (RHC)p19See also All Rural Providers

                    Rural Referral Center (RHC)p 19See also All Rural Providers

                    Skilled Nursing Facility (SNF)pp 17 19 21

                    Social Worker Clinicalp 7

                    Sole Community Hospital p 19See All Rural Providers and Hospital

                    Supplierpp 10-11 20

                    Teacherpp 3 5 6

                    X-Ray Facility Portablepp 7-8

                    NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                    PROVIDER INDEX

                    ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                    2828

                    Official CMS Information for Medicare Fee-For-Service Providers

                    httpwwwcmshhsgovMLNProducts

                    SUBJ

                    ECT

                    INDE

                    X

                    Appealsp 10

                    Articlesp 4

                    AV Fistulap 20

                    Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                    Bone Mass Measurementp 9

                    Bookletsp 8

                    Bookmarkspp 6 7 22

                    Brochurespp 9-11

                    Cancer p 9

                    Certificate Of Medical Necessity (CMN)p 20

                    Chiropracticp 12

                    Claims Reviewp 8

                    Clinical Laboratory Improvement Amendments (CLIA)p 9

                    CMS Form 1500pp 13 20

                    Diabetesp10

                    Electronic Prescribing (E-Prescribing)pp 22 25

                    Email Subscription Service p12

                    Emergency Health Servicesp 17

                    SUBJECT INDEXEnrollment Reportingp 13

                    Evaluation And Management Services (EampM) p 2

                    Fact Sheetspp 12-19 22-24

                    Fee Schedulespp 12 16

                    Fraud And Abusepp 16 21

                    Glaucomap 10

                    Guidespp 2 3 25

                    Hospital Acquired Conditions (HAC)p 14

                    Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                    Hospital Outpatient Prospective Payment System (OPPS)p 14

                    ICD-9-CM Diagnosis Coding pp 20 23

                    ICD-10-CM Procedure Codingp 23

                    Immunizationpp 7 9

                    Kidney Dialysis Transplant ESRDpp 2 16 20

                    Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                    Manualsp 9

                    Medicaidp 11

                    httpwwwcmshhsgovMLNProducts

                    29Official CMS Information for Medicare Fee-For-Service Providers

                    SUBJECT INDEX

                    29

                    Medical Reviewp 11

                    Medicarepp 21 25

                    Medicare Learning Network (MLN)pp 4-6 18

                    Medicare Remit Easy Print (MREP)p 10

                    Medicare Secondary Payer (MSP)p 16

                    Outpatient Code Editor (OCE)p 21

                    Overpaymentsp 11

                    Physical Examination (IPPE)pp 7 10

                    Physician Fee Schedule (MPSF)p 16

                    Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                    Podiatry Servicesp 16

                    Power Mobility Devices (PMDs)p 9

                    Practice Managementpp 2-3 7 11-12 16 21

                    Present On Admission (POA)p 17

                    Preventive Servicespp 2 6-11 21

                    Privacyp 16

                    Prospective Payment Systemspp 12-15 17 20

                    Quick Reference Chartspp 7 22 24

                    Rehabilitation Therapy p 17

                    Remittance Advice (RA)p 3

                    Rural Healthpp 5 7 18-19

                    Smoking Cessationp 11

                    SNF Consolidated Billingp 21

                    Special Initiativespp 22-24

                    Spell Of Illnessp 7

                    Swing Bedp 19

                    Telehealth Servicesp 19

                    UB-04pp 14 21

                    Undocumented Aliensp 17

                    Web Addresses Resourcespp 5 25

                    Web-Based Trainingpp 20 21

                    Womenrsquos Healthp 21

                    Official CMS Information for Medicare Fee-For-Service Providers

                    November 2009

                    ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                    R

                    • INTRODUCTION13
                    • TABLE OF CONTENTS
                    • GUIDES
                    • ARTICLES
                    • EDUCATIONAL TOOLS
                    • BOOKLETS
                    • BROCHURES
                    • FACT SHEETS13
                    • TRAINING PRESENTATIONS13
                    • WEB-BASED TRAINING13
                    • SPECIAL INITIATIVES13
                    • HELPFUL RESOURCES13
                    • PROVIDER INDEX
                    • SUBJECT INDEX

                      httpwwwcmshhsgovMLNProducts

                      9Official CMS Information for Medicare Fee-For-Service Providers

                      BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                      Adult ImmunizationsThis tri-fold brochure provides a basic overview of Medicarersquos Influenza Vaccine Pneumococcal Vaccine (PPV) and Hepatitis B Vaccine benefits (September 2009) (ICN006435) Formats Available Downloadable only

                      Suggested For All Medicare Fee-For-Service Providers

                      Bone Mass Measurements This tri-fold brochure provides a basic overview of Medicarersquos bone mass measurements (bone density studies) benefit (July 2009) (ICN006437) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                      Cancer Screenings This tri-fold brochure provides a basic overview of Medicarersquos mammography screening screening Pap test pelvic screening examination colorectal cancer screening and prostate cancer screening benefits (July 2009) (ICN006434) Formats Available Downloadable only

                      Suggested For All Medicare Fee-For-Service Providers

                      Overview of Medicare Coverage of Power Mobility Devices (PMDs)Power Wheelchairs and PowerOperated Vehicles (POVs)This brochure describes CMSrsquo multi-faceted plan to ensure the appropriate prescription of PMDs to beneficiaries who need them

                      (March 2009) (ICN006265) Suggested For DMEPOS Suppliers NPP Physicians Rehabilitation Facilities

                      Clinical Laboratory Improvement Amendments (CLIA)This brochure includes an overview of CLIA test methods categorized enrollment in the CLIA program types of certificates certificate compliance performance measures and certificate of accreditation

                      (April 2009) (ICN006270) Suggested For ASC Clinics Diagnostic Testing Facilities ESRD Facilities Hospitals Laboratories Physicians Other Institutions

                      The CMS Online Manual SystemThis brochure explains how to navigate the CMS Online Manual System website (February 2008) (ICN006267) Suggested For All Medicare Fee-For-Service Providers

                      BROCHURES

                      10

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                      Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

                      (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                      Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

                      Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                      Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                      The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

                      and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

                      Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

                      BROC

                      HURE

                      S

                      httpwwwcmshhsgovMLNProducts

                      11Official CMS Information for Medicare Fee-For-Service Providers

                      The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

                      health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

                      The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

                      covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                      Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

                      Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

                      What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                      BROCHURES

                      ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

                      12

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

                      payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

                      Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

                      chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

                      Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

                      Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

                      are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

                      Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

                      CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

                      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                      FACT

                      SHE

                      ETS

                      httpwwwcmshhsgovMLNProducts

                      13Official CMS Information for Medicare Fee-For-Service Providers

                      Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                      reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                      Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                      for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                      Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                      are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                      Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                      a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                      Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                      documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                      Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                      (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                      FACT SHEETS

                      14

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                      Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                      (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                      Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                      fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                      Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                      4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                      Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                      information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                      Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                      the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                      Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                      the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                      FACT

                      SHE

                      ETS

                      httpwwwcmshhsgovMLNProducts

                      15Official CMS Information for Medicare Fee-For-Service Providers

                      Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                      and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                      Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                      4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                      Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                      9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                      Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                      System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                      Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                      Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                      Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                      8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                      FACT SHEETS

                      16

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                      Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                      on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                      Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                      Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                      Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                      Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                      Downloadable only Suggested For NPP Physicians

                      Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                      settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                      Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                      separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                      ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                      FACT

                      SHE

                      ETS

                      httpwwwcmshhsgovMLNProducts

                      17Official CMS Information for Medicare Fee-For-Service Providers

                      Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                      of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                      Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                      of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                      Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                      as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                      Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                      FACT SHEETS

                      Official CMS Information for Medicare Fee-For-Service Providers

                      18

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                      Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                      and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                      Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                      Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                      Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                      Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                      payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                      Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                      Downloadable only Suggested For Hospitals

                      Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                      Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                      FACT

                      SHE

                      ETS

                      httpwwwcmshhsgovMLNProducts

                      19Official CMS Information for Medicare Fee-For-Service Providers

                      Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                      Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                      Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                      Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                      Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                      or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                      Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                      4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                      Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                      sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                      FACT SHEETS

                      20

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      Training Presentations

                      Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                      Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                      CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                      Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                      Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                      WEB

                      -BAS

                      ED T

                      RAIN

                      ING

                      TRAI

                      NING

                      PRE

                      SENT

                      ATIO

                      NS

                      Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                      httpwwwcmshhsgovMLNProducts

                      21Official CMS Information for Medicare Fee-For-Service Providers

                      Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                      Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                      Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                      Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                      Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                      Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                      Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                      World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                      WEB-BASED TRAINING

                      22

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                      2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                      2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                      2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                      ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                      ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                      ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                      Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                      ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                      SPEC

                      IAL

                      INIT

                      IATI

                      VES

                      httpwwwcmshhsgovMLNProducts

                      23Official CMS Information for Medicare Fee-For-Service Providers

                      General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                      Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                      Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                      2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                      2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                      PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                      2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                      2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                      2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                      SPECIAL INITIATIVES

                      24

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                      2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                      2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                      2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                      PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                      2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                      SPEC

                      IAL

                      INIT

                      IATI

                      VES

                      ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                      httpwwwcmshhsgovMLNProducts

                      25Official CMS Information for Medicare Fee-For-Service Providers

                      Helpful Resources

                      Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                      Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                      Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                      Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                      ICD-10httpwwwcmshhsgovICD10

                      Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                      Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                      Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                      Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                      Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                      Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                      Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                      HELPFUL RESOURCES

                      26

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts26

                      All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                      All Institutional Providerspp 9 14 20 21

                      All Part B Providerspp 11 13

                      All Rural Providerspp 5 7 18 19

                      Ambulance Supplierpp 10-12 17 20

                      Ambulatory Surgical Center (ASC)pp 9 12

                      Chiropractorp 12

                      Clinics Group Practicespp 5 7-9 13

                      Community Mental Health Centerp 14See All Institutional Providers

                      Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                      Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                      Diagnostic Testing Facility Independent (IDTF)pp 7-9

                      Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                      End Stage Renal Disease Facility (ESRD)pp 9 16 20

                      Facilitatorpp 3 5 6

                      Federally Qualified Health Center (FQHC)pp 18-19

                      PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                      Hospicep 14

                      Hospitalpp 3 7-9 12-15 16-20

                      Indian Health Service Facility (IHS)pp 6 14 17

                      Inpatient Rehabilitation Facilitypp 9 15

                      Laboratory Independent Clinical (ICL)pp 7-9

                      Long Term Care Hospital (LTCH)p 15

                      Mammography Centerpp 7-8

                      Medical Billers Coderspp 17 22 23

                      Medicare Dependent Hospitalp 18

                      NPP Non-Physician Practitionerpp 2 5-25

                      Nurse Anesthetist (CRNA)pp 2 5-25

                      Nurse Midwife (CNM)pp 2 5-25

                      Nurse Practitioner (NP)pp 2 5-25

                      Nurse Specialist (CNS)pp 2 5-25

                      Pharmacy PharmacistSee Supplier

                      Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                      PROV

                      IDER

                      INDE

                      X

                      httpwwwcmshhsgovMLNProducts

                      27Official CMS Information for Medicare Fee-For-Service Providers 27

                      Physicianpp 2 5-25

                      Physician Assistant (PA)pp 2 5-25

                      Psychologist Clinical See All Part B Providers

                      Psychiatric HospitalSee Hospital

                      Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                      Rural Health Clinic (RHC)p19See also All Rural Providers

                      Rural Referral Center (RHC)p 19See also All Rural Providers

                      Skilled Nursing Facility (SNF)pp 17 19 21

                      Social Worker Clinicalp 7

                      Sole Community Hospital p 19See All Rural Providers and Hospital

                      Supplierpp 10-11 20

                      Teacherpp 3 5 6

                      X-Ray Facility Portablepp 7-8

                      NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                      PROVIDER INDEX

                      ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                      2828

                      Official CMS Information for Medicare Fee-For-Service Providers

                      httpwwwcmshhsgovMLNProducts

                      SUBJ

                      ECT

                      INDE

                      X

                      Appealsp 10

                      Articlesp 4

                      AV Fistulap 20

                      Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                      Bone Mass Measurementp 9

                      Bookletsp 8

                      Bookmarkspp 6 7 22

                      Brochurespp 9-11

                      Cancer p 9

                      Certificate Of Medical Necessity (CMN)p 20

                      Chiropracticp 12

                      Claims Reviewp 8

                      Clinical Laboratory Improvement Amendments (CLIA)p 9

                      CMS Form 1500pp 13 20

                      Diabetesp10

                      Electronic Prescribing (E-Prescribing)pp 22 25

                      Email Subscription Service p12

                      Emergency Health Servicesp 17

                      SUBJECT INDEXEnrollment Reportingp 13

                      Evaluation And Management Services (EampM) p 2

                      Fact Sheetspp 12-19 22-24

                      Fee Schedulespp 12 16

                      Fraud And Abusepp 16 21

                      Glaucomap 10

                      Guidespp 2 3 25

                      Hospital Acquired Conditions (HAC)p 14

                      Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                      Hospital Outpatient Prospective Payment System (OPPS)p 14

                      ICD-9-CM Diagnosis Coding pp 20 23

                      ICD-10-CM Procedure Codingp 23

                      Immunizationpp 7 9

                      Kidney Dialysis Transplant ESRDpp 2 16 20

                      Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                      Manualsp 9

                      Medicaidp 11

                      httpwwwcmshhsgovMLNProducts

                      29Official CMS Information for Medicare Fee-For-Service Providers

                      SUBJECT INDEX

                      29

                      Medical Reviewp 11

                      Medicarepp 21 25

                      Medicare Learning Network (MLN)pp 4-6 18

                      Medicare Remit Easy Print (MREP)p 10

                      Medicare Secondary Payer (MSP)p 16

                      Outpatient Code Editor (OCE)p 21

                      Overpaymentsp 11

                      Physical Examination (IPPE)pp 7 10

                      Physician Fee Schedule (MPSF)p 16

                      Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                      Podiatry Servicesp 16

                      Power Mobility Devices (PMDs)p 9

                      Practice Managementpp 2-3 7 11-12 16 21

                      Present On Admission (POA)p 17

                      Preventive Servicespp 2 6-11 21

                      Privacyp 16

                      Prospective Payment Systemspp 12-15 17 20

                      Quick Reference Chartspp 7 22 24

                      Rehabilitation Therapy p 17

                      Remittance Advice (RA)p 3

                      Rural Healthpp 5 7 18-19

                      Smoking Cessationp 11

                      SNF Consolidated Billingp 21

                      Special Initiativespp 22-24

                      Spell Of Illnessp 7

                      Swing Bedp 19

                      Telehealth Servicesp 19

                      UB-04pp 14 21

                      Undocumented Aliensp 17

                      Web Addresses Resourcespp 5 25

                      Web-Based Trainingpp 20 21

                      Womenrsquos Healthp 21

                      Official CMS Information for Medicare Fee-For-Service Providers

                      November 2009

                      ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                      R

                      • INTRODUCTION13
                      • TABLE OF CONTENTS
                      • GUIDES
                      • ARTICLES
                      • EDUCATIONAL TOOLS
                      • BOOKLETS
                      • BROCHURES
                      • FACT SHEETS13
                      • TRAINING PRESENTATIONS13
                      • WEB-BASED TRAINING13
                      • SPECIAL INITIATIVES13
                      • HELPFUL RESOURCES13
                      • PROVIDER INDEX
                      • SUBJECT INDEX

                        10

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        BrochuresAll Brochures are available as Hard Copy Downloadable unless otherwise noted

                        Diabetes-Related Services This tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of diabetes screening tests diabetes self-management training medical nutrition therapy and supplies and other services for Medicare beneficiaries with diabetes

                        (July 2009) (ICN006840) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                        Expanded BenefitsThis tri-fold brochure provides health care professionals with an overview of Medicarersquos coverage of three new preventive services the Initial Preventive Physical Examination (IPPE) also known as the ldquoWelcome to Medicare Physical Examrdquo or the ldquoWelcome to Medicare

                        Visitrdquo ultrasound screening for abdominal aortic aneurysms and cardiovascular screening blood tests (July 2009) (ICN006433) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                        Glaucoma Screening This tri-fold brochure provides a basic overview of Medicarersquos glaucoma screening benefit (July 2009) (ICN006436) Formats Available Downloadable only Suggested For All Medicare Fee-For-Service Providers

                        The Medicare Appeals Process Five Levels To Protect Providers Physicians And Other Suppliers This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers physicians and other suppliers who provide services

                        and supplies to Medicare beneficiaries as well as details on where to obtain more information about this appeals process (January 2008) (ICN006562) Suggested For All Medicare Fee-For-Service Providers

                        Medicare Remit Easy Print (MREP)This brochure provides information about MREP software which enables physicians and suppliers to view and print their remittance information Tri-fold brochure (February 2008) (ICN006740) Suggested For DMEPOS Suppliers NPP Physicians Other Health Care Suppliers

                        BROC

                        HURE

                        S

                        httpwwwcmshhsgovMLNProducts

                        11Official CMS Information for Medicare Fee-For-Service Providers

                        The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

                        health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

                        The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

                        covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                        Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

                        Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

                        What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                        BROCHURES

                        ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

                        12

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

                        payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

                        Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

                        chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

                        Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

                        Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

                        are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

                        Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

                        CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

                        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                        FACT

                        SHE

                        ETS

                        httpwwwcmshhsgovMLNProducts

                        13Official CMS Information for Medicare Fee-For-Service Providers

                        Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                        reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                        Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                        for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                        Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                        are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                        Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                        a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                        Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                        documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                        Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                        (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                        FACT SHEETS

                        14

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                        Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                        (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                        Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                        fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                        Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                        4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                        Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                        information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                        Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                        the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                        Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                        the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                        FACT

                        SHE

                        ETS

                        httpwwwcmshhsgovMLNProducts

                        15Official CMS Information for Medicare Fee-For-Service Providers

                        Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                        and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                        Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                        4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                        Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                        9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                        Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                        System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                        Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                        Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                        Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                        8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                        FACT SHEETS

                        16

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                        Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                        on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                        Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                        Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                        Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                        Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                        Downloadable only Suggested For NPP Physicians

                        Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                        settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                        Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                        separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                        ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                        FACT

                        SHE

                        ETS

                        httpwwwcmshhsgovMLNProducts

                        17Official CMS Information for Medicare Fee-For-Service Providers

                        Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                        of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                        Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                        of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                        Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                        as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                        Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                        FACT SHEETS

                        Official CMS Information for Medicare Fee-For-Service Providers

                        18

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                        Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                        and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                        Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                        Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                        Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                        Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                        payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                        Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                        Downloadable only Suggested For Hospitals

                        Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                        Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                        FACT

                        SHE

                        ETS

                        httpwwwcmshhsgovMLNProducts

                        19Official CMS Information for Medicare Fee-For-Service Providers

                        Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                        Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                        Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                        Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                        Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                        or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                        Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                        4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                        Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                        sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                        FACT SHEETS

                        20

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        Training Presentations

                        Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                        Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                        CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                        Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                        Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                        WEB

                        -BAS

                        ED T

                        RAIN

                        ING

                        TRAI

                        NING

                        PRE

                        SENT

                        ATIO

                        NS

                        Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                        httpwwwcmshhsgovMLNProducts

                        21Official CMS Information for Medicare Fee-For-Service Providers

                        Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                        Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                        Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                        Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                        Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                        Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                        Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                        World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                        WEB-BASED TRAINING

                        22

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                        2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                        2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                        2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                        ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                        ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                        ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                        Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                        ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                        SPEC

                        IAL

                        INIT

                        IATI

                        VES

                        httpwwwcmshhsgovMLNProducts

                        23Official CMS Information for Medicare Fee-For-Service Providers

                        General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                        Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                        Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                        2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                        2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                        PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                        2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                        2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                        2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                        SPECIAL INITIATIVES

                        24

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                        2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                        2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                        2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                        PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                        2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                        SPEC

                        IAL

                        INIT

                        IATI

                        VES

                        ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                        httpwwwcmshhsgovMLNProducts

                        25Official CMS Information for Medicare Fee-For-Service Providers

                        Helpful Resources

                        Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                        Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                        Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                        Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                        ICD-10httpwwwcmshhsgovICD10

                        Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                        Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                        Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                        Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                        Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                        Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                        Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                        HELPFUL RESOURCES

                        26

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts26

                        All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                        All Institutional Providerspp 9 14 20 21

                        All Part B Providerspp 11 13

                        All Rural Providerspp 5 7 18 19

                        Ambulance Supplierpp 10-12 17 20

                        Ambulatory Surgical Center (ASC)pp 9 12

                        Chiropractorp 12

                        Clinics Group Practicespp 5 7-9 13

                        Community Mental Health Centerp 14See All Institutional Providers

                        Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                        Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                        Diagnostic Testing Facility Independent (IDTF)pp 7-9

                        Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                        End Stage Renal Disease Facility (ESRD)pp 9 16 20

                        Facilitatorpp 3 5 6

                        Federally Qualified Health Center (FQHC)pp 18-19

                        PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                        Hospicep 14

                        Hospitalpp 3 7-9 12-15 16-20

                        Indian Health Service Facility (IHS)pp 6 14 17

                        Inpatient Rehabilitation Facilitypp 9 15

                        Laboratory Independent Clinical (ICL)pp 7-9

                        Long Term Care Hospital (LTCH)p 15

                        Mammography Centerpp 7-8

                        Medical Billers Coderspp 17 22 23

                        Medicare Dependent Hospitalp 18

                        NPP Non-Physician Practitionerpp 2 5-25

                        Nurse Anesthetist (CRNA)pp 2 5-25

                        Nurse Midwife (CNM)pp 2 5-25

                        Nurse Practitioner (NP)pp 2 5-25

                        Nurse Specialist (CNS)pp 2 5-25

                        Pharmacy PharmacistSee Supplier

                        Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                        PROV

                        IDER

                        INDE

                        X

                        httpwwwcmshhsgovMLNProducts

                        27Official CMS Information for Medicare Fee-For-Service Providers 27

                        Physicianpp 2 5-25

                        Physician Assistant (PA)pp 2 5-25

                        Psychologist Clinical See All Part B Providers

                        Psychiatric HospitalSee Hospital

                        Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                        Rural Health Clinic (RHC)p19See also All Rural Providers

                        Rural Referral Center (RHC)p 19See also All Rural Providers

                        Skilled Nursing Facility (SNF)pp 17 19 21

                        Social Worker Clinicalp 7

                        Sole Community Hospital p 19See All Rural Providers and Hospital

                        Supplierpp 10-11 20

                        Teacherpp 3 5 6

                        X-Ray Facility Portablepp 7-8

                        NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                        PROVIDER INDEX

                        ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                        2828

                        Official CMS Information for Medicare Fee-For-Service Providers

                        httpwwwcmshhsgovMLNProducts

                        SUBJ

                        ECT

                        INDE

                        X

                        Appealsp 10

                        Articlesp 4

                        AV Fistulap 20

                        Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                        Bone Mass Measurementp 9

                        Bookletsp 8

                        Bookmarkspp 6 7 22

                        Brochurespp 9-11

                        Cancer p 9

                        Certificate Of Medical Necessity (CMN)p 20

                        Chiropracticp 12

                        Claims Reviewp 8

                        Clinical Laboratory Improvement Amendments (CLIA)p 9

                        CMS Form 1500pp 13 20

                        Diabetesp10

                        Electronic Prescribing (E-Prescribing)pp 22 25

                        Email Subscription Service p12

                        Emergency Health Servicesp 17

                        SUBJECT INDEXEnrollment Reportingp 13

                        Evaluation And Management Services (EampM) p 2

                        Fact Sheetspp 12-19 22-24

                        Fee Schedulespp 12 16

                        Fraud And Abusepp 16 21

                        Glaucomap 10

                        Guidespp 2 3 25

                        Hospital Acquired Conditions (HAC)p 14

                        Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                        Hospital Outpatient Prospective Payment System (OPPS)p 14

                        ICD-9-CM Diagnosis Coding pp 20 23

                        ICD-10-CM Procedure Codingp 23

                        Immunizationpp 7 9

                        Kidney Dialysis Transplant ESRDpp 2 16 20

                        Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                        Manualsp 9

                        Medicaidp 11

                        httpwwwcmshhsgovMLNProducts

                        29Official CMS Information for Medicare Fee-For-Service Providers

                        SUBJECT INDEX

                        29

                        Medical Reviewp 11

                        Medicarepp 21 25

                        Medicare Learning Network (MLN)pp 4-6 18

                        Medicare Remit Easy Print (MREP)p 10

                        Medicare Secondary Payer (MSP)p 16

                        Outpatient Code Editor (OCE)p 21

                        Overpaymentsp 11

                        Physical Examination (IPPE)pp 7 10

                        Physician Fee Schedule (MPSF)p 16

                        Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                        Podiatry Servicesp 16

                        Power Mobility Devices (PMDs)p 9

                        Practice Managementpp 2-3 7 11-12 16 21

                        Present On Admission (POA)p 17

                        Preventive Servicespp 2 6-11 21

                        Privacyp 16

                        Prospective Payment Systemspp 12-15 17 20

                        Quick Reference Chartspp 7 22 24

                        Rehabilitation Therapy p 17

                        Remittance Advice (RA)p 3

                        Rural Healthpp 5 7 18-19

                        Smoking Cessationp 11

                        SNF Consolidated Billingp 21

                        Special Initiativespp 22-24

                        Spell Of Illnessp 7

                        Swing Bedp 19

                        Telehealth Servicesp 19

                        UB-04pp 14 21

                        Undocumented Aliensp 17

                        Web Addresses Resourcespp 5 25

                        Web-Based Trainingpp 20 21

                        Womenrsquos Healthp 21

                        Official CMS Information for Medicare Fee-For-Service Providers

                        November 2009

                        ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                        R

                        • INTRODUCTION13
                        • TABLE OF CONTENTS
                        • GUIDES
                        • ARTICLES
                        • EDUCATIONAL TOOLS
                        • BOOKLETS
                        • BROCHURES
                        • FACT SHEETS13
                        • TRAINING PRESENTATIONS13
                        • WEB-BASED TRAINING13
                        • SPECIAL INITIATIVES13
                        • HELPFUL RESOURCES13
                        • PROVIDER INDEX
                        • SUBJECT INDEX

                          httpwwwcmshhsgovMLNProducts

                          11Official CMS Information for Medicare Fee-For-Service Providers

                          The Medicare-Medicaid RelationshipThis brochure describes situations in which Medicare beneficiaries who have low incomes and limited resources may also receive help from the Medicaid Program For such persons who are eligible for full Medicaid coverage the Medicare

                          health care coverage is supplemented by services that are available under their Statersquos Medicaid program (September 2006) (ICN006378) (Last reviewed August 2009)Suggested For All Medicare Fee-For-Service Providers

                          The Medicare Medical Review (MR) Program This brochure provides a general overview of the Medicare Review (MR) program to help Medicare Part B providers gain a better understanding of their role in the MR process Topics

                          covered include What is MR The objectives of the MR program What are National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) the MR process corrective action and provider rights 4 pages (July 2007) (ICN006346) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                          Protecting Your PracticeThis brochure highlights some of the steps Medicare physicians and other health care professionals take to protect medical practices from inappropriate Medicare business interactions (May 2009) (ICN006386) Suggested For NPP Physicians Health Care Suppliers

                          Smoking and Tobacco-Use Cessation Counseling Services This tri-fold brochure provides an overview of Medicarersquos smoking and tobacco-use cessation counseling service benefit (July 2009) (ICN006767) Suggested For All Medicare Fee-For-Service Providers

                          What Physicians and Other Suppliers Should Know About Medicare Overpayments This brochure provides a general overview of the overpayment process for Medicare Part B providers (May 2009) (ICN006379) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                          BROCHURES

                          ldquoThis catalog is a good source for finding the current version of the products that CMS offers to providersrdquo ndash CMS Website User

                          12

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

                          payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

                          Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

                          chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

                          Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

                          Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

                          are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

                          Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

                          CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

                          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                          FACT

                          SHE

                          ETS

                          httpwwwcmshhsgovMLNProducts

                          13Official CMS Information for Medicare Fee-For-Service Providers

                          Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                          reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                          Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                          for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                          Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                          are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                          Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                          a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                          Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                          documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                          Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                          (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                          FACT SHEETS

                          14

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                          Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                          (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                          Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                          fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                          Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                          4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                          Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                          information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                          Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                          the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                          Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                          the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                          FACT

                          SHE

                          ETS

                          httpwwwcmshhsgovMLNProducts

                          15Official CMS Information for Medicare Fee-For-Service Providers

                          Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                          and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                          Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                          4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                          Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                          9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                          Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                          System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                          Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                          Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                          Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                          8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                          FACT SHEETS

                          16

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                          Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                          on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                          Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                          Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                          Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                          Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                          Downloadable only Suggested For NPP Physicians

                          Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                          settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                          Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                          separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                          ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                          FACT

                          SHE

                          ETS

                          httpwwwcmshhsgovMLNProducts

                          17Official CMS Information for Medicare Fee-For-Service Providers

                          Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                          of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                          Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                          of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                          Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                          as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                          Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                          FACT SHEETS

                          Official CMS Information for Medicare Fee-For-Service Providers

                          18

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                          Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                          and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                          Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                          Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                          Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                          Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                          payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                          Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                          Downloadable only Suggested For Hospitals

                          Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                          Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                          FACT

                          SHE

                          ETS

                          httpwwwcmshhsgovMLNProducts

                          19Official CMS Information for Medicare Fee-For-Service Providers

                          Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                          Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                          Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                          Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                          Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                          or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                          Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                          4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                          Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                          sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                          FACT SHEETS

                          20

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          Training Presentations

                          Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                          Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                          CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                          Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                          Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                          WEB

                          -BAS

                          ED T

                          RAIN

                          ING

                          TRAI

                          NING

                          PRE

                          SENT

                          ATIO

                          NS

                          Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                          httpwwwcmshhsgovMLNProducts

                          21Official CMS Information for Medicare Fee-For-Service Providers

                          Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                          Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                          Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                          Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                          Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                          Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                          Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                          World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                          WEB-BASED TRAINING

                          22

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                          2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                          2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                          2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                          ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                          ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                          ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                          Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                          ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                          SPEC

                          IAL

                          INIT

                          IATI

                          VES

                          httpwwwcmshhsgovMLNProducts

                          23Official CMS Information for Medicare Fee-For-Service Providers

                          General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                          Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                          Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                          2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                          2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                          PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                          2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                          2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                          2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                          SPECIAL INITIATIVES

                          24

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                          2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                          2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                          2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                          PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                          2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                          SPEC

                          IAL

                          INIT

                          IATI

                          VES

                          ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                          httpwwwcmshhsgovMLNProducts

                          25Official CMS Information for Medicare Fee-For-Service Providers

                          Helpful Resources

                          Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                          Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                          Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                          Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                          ICD-10httpwwwcmshhsgovICD10

                          Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                          Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                          Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                          Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                          Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                          Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                          Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                          HELPFUL RESOURCES

                          26

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts26

                          All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                          All Institutional Providerspp 9 14 20 21

                          All Part B Providerspp 11 13

                          All Rural Providerspp 5 7 18 19

                          Ambulance Supplierpp 10-12 17 20

                          Ambulatory Surgical Center (ASC)pp 9 12

                          Chiropractorp 12

                          Clinics Group Practicespp 5 7-9 13

                          Community Mental Health Centerp 14See All Institutional Providers

                          Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                          Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                          Diagnostic Testing Facility Independent (IDTF)pp 7-9

                          Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                          End Stage Renal Disease Facility (ESRD)pp 9 16 20

                          Facilitatorpp 3 5 6

                          Federally Qualified Health Center (FQHC)pp 18-19

                          PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                          Hospicep 14

                          Hospitalpp 3 7-9 12-15 16-20

                          Indian Health Service Facility (IHS)pp 6 14 17

                          Inpatient Rehabilitation Facilitypp 9 15

                          Laboratory Independent Clinical (ICL)pp 7-9

                          Long Term Care Hospital (LTCH)p 15

                          Mammography Centerpp 7-8

                          Medical Billers Coderspp 17 22 23

                          Medicare Dependent Hospitalp 18

                          NPP Non-Physician Practitionerpp 2 5-25

                          Nurse Anesthetist (CRNA)pp 2 5-25

                          Nurse Midwife (CNM)pp 2 5-25

                          Nurse Practitioner (NP)pp 2 5-25

                          Nurse Specialist (CNS)pp 2 5-25

                          Pharmacy PharmacistSee Supplier

                          Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                          PROV

                          IDER

                          INDE

                          X

                          httpwwwcmshhsgovMLNProducts

                          27Official CMS Information for Medicare Fee-For-Service Providers 27

                          Physicianpp 2 5-25

                          Physician Assistant (PA)pp 2 5-25

                          Psychologist Clinical See All Part B Providers

                          Psychiatric HospitalSee Hospital

                          Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                          Rural Health Clinic (RHC)p19See also All Rural Providers

                          Rural Referral Center (RHC)p 19See also All Rural Providers

                          Skilled Nursing Facility (SNF)pp 17 19 21

                          Social Worker Clinicalp 7

                          Sole Community Hospital p 19See All Rural Providers and Hospital

                          Supplierpp 10-11 20

                          Teacherpp 3 5 6

                          X-Ray Facility Portablepp 7-8

                          NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                          PROVIDER INDEX

                          ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                          2828

                          Official CMS Information for Medicare Fee-For-Service Providers

                          httpwwwcmshhsgovMLNProducts

                          SUBJ

                          ECT

                          INDE

                          X

                          Appealsp 10

                          Articlesp 4

                          AV Fistulap 20

                          Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                          Bone Mass Measurementp 9

                          Bookletsp 8

                          Bookmarkspp 6 7 22

                          Brochurespp 9-11

                          Cancer p 9

                          Certificate Of Medical Necessity (CMN)p 20

                          Chiropracticp 12

                          Claims Reviewp 8

                          Clinical Laboratory Improvement Amendments (CLIA)p 9

                          CMS Form 1500pp 13 20

                          Diabetesp10

                          Electronic Prescribing (E-Prescribing)pp 22 25

                          Email Subscription Service p12

                          Emergency Health Servicesp 17

                          SUBJECT INDEXEnrollment Reportingp 13

                          Evaluation And Management Services (EampM) p 2

                          Fact Sheetspp 12-19 22-24

                          Fee Schedulespp 12 16

                          Fraud And Abusepp 16 21

                          Glaucomap 10

                          Guidespp 2 3 25

                          Hospital Acquired Conditions (HAC)p 14

                          Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                          Hospital Outpatient Prospective Payment System (OPPS)p 14

                          ICD-9-CM Diagnosis Coding pp 20 23

                          ICD-10-CM Procedure Codingp 23

                          Immunizationpp 7 9

                          Kidney Dialysis Transplant ESRDpp 2 16 20

                          Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                          Manualsp 9

                          Medicaidp 11

                          httpwwwcmshhsgovMLNProducts

                          29Official CMS Information for Medicare Fee-For-Service Providers

                          SUBJECT INDEX

                          29

                          Medical Reviewp 11

                          Medicarepp 21 25

                          Medicare Learning Network (MLN)pp 4-6 18

                          Medicare Remit Easy Print (MREP)p 10

                          Medicare Secondary Payer (MSP)p 16

                          Outpatient Code Editor (OCE)p 21

                          Overpaymentsp 11

                          Physical Examination (IPPE)pp 7 10

                          Physician Fee Schedule (MPSF)p 16

                          Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                          Podiatry Servicesp 16

                          Power Mobility Devices (PMDs)p 9

                          Practice Managementpp 2-3 7 11-12 16 21

                          Present On Admission (POA)p 17

                          Preventive Servicespp 2 6-11 21

                          Privacyp 16

                          Prospective Payment Systemspp 12-15 17 20

                          Quick Reference Chartspp 7 22 24

                          Rehabilitation Therapy p 17

                          Remittance Advice (RA)p 3

                          Rural Healthpp 5 7 18-19

                          Smoking Cessationp 11

                          SNF Consolidated Billingp 21

                          Special Initiativespp 22-24

                          Spell Of Illnessp 7

                          Swing Bedp 19

                          Telehealth Servicesp 19

                          UB-04pp 14 21

                          Undocumented Aliensp 17

                          Web Addresses Resourcespp 5 25

                          Web-Based Trainingpp 20 21

                          Womenrsquos Healthp 21

                          Official CMS Information for Medicare Fee-For-Service Providers

                          November 2009

                          ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                          R

                          • INTRODUCTION13
                          • TABLE OF CONTENTS
                          • GUIDES
                          • ARTICLES
                          • EDUCATIONAL TOOLS
                          • BOOKLETS
                          • BROCHURES
                          • FACT SHEETS13
                          • TRAINING PRESENTATIONS13
                          • WEB-BASED TRAINING13
                          • SPECIAL INITIATIVES13
                          • HELPFUL RESOURCES13
                          • PROVIDER INDEX
                          • SUBJECT INDEX

                            12

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            Acute Care Hospital Inpatient Prospective Payment SystemThis fact sheet provides general information about the Acute Care Hospital Inpatient Prospective Payment System (IPPS) including information about the basis for IPPS

                            payment IPPS payment rates and how IPPS payment rates are set 6 pages (September 2009) (ICN006815) Suggested For Hospitals NPP Physicians

                            Addressing Misinformation Regarding Chiropractic Services And Medicare This fact sheet is being provided by the Centers for Medicare amp Medicaid Services (CMS) to correct misinformation in the

                            chiropractic community relating to Medicare and its regulations as they relate to chiropractic services This fact sheet is informational only and represents no changes to existing Medicare policy 3 pages (April 2008) (ICN006953) Formats Available Downloadable only Suggested For Chiropractors

                            Ambulance Fee Schedule This fact sheet provides general information about the Ambulance Fee Schedule 4 pages (January 2009) (ICN006835) Suggested For Ambulance Suppliers

                            Ambulatory Surgical Center (ASC) Fee Schedule This fact sheet provides general information about the Ambulatory Surgical Center (ASC) Fee Schedule ASC payments and how ASC payment amounts

                            are determined 4 pages (January 2009) (ICN006819) Suggested For ASC Hospitals NPP Physicians

                            Clinical Laboratory Fee Schedule This fact sheet provides general information about the Clinical Laboratory Fee Schedule coverage of clinical laboratory services and how payment rates are set 4 pages (February 2009) (ICN006818) Suggested For All Medicare Fee-For-Service Providers

                            CMS E-Mail Subscription Service This fact sheet keeps Medicare Fee-For-Service Providers informed about the CMS ldquomailing listsrdquo that are currently available 1 page (August 2009) (ICN006785) Suggested For All Medicare Providers

                            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                            FACT

                            SHE

                            ETS

                            httpwwwcmshhsgovMLNProducts

                            13Official CMS Information for Medicare Fee-For-Service Providers

                            Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                            reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                            Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                            for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                            Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                            are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                            Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                            a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                            Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                            documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                            Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                            (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                            FACT SHEETS

                            14

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                            Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                            (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                            Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                            fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                            Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                            4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                            Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                            information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                            Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                            the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                            Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                            the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                            FACT

                            SHE

                            ETS

                            httpwwwcmshhsgovMLNProducts

                            15Official CMS Information for Medicare Fee-For-Service Providers

                            Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                            and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                            Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                            4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                            Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                            9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                            Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                            System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                            Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                            Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                            Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                            8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                            FACT SHEETS

                            16

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                            Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                            on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                            Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                            Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                            Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                            Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                            Downloadable only Suggested For NPP Physicians

                            Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                            settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                            Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                            separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                            ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                            FACT

                            SHE

                            ETS

                            httpwwwcmshhsgovMLNProducts

                            17Official CMS Information for Medicare Fee-For-Service Providers

                            Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                            of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                            Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                            of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                            Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                            as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                            Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                            FACT SHEETS

                            Official CMS Information for Medicare Fee-For-Service Providers

                            18

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                            Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                            and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                            Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                            Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                            Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                            Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                            payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                            Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                            Downloadable only Suggested For Hospitals

                            Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                            Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                            FACT

                            SHE

                            ETS

                            httpwwwcmshhsgovMLNProducts

                            19Official CMS Information for Medicare Fee-For-Service Providers

                            Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                            Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                            Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                            Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                            Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                            or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                            Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                            4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                            Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                            sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                            FACT SHEETS

                            20

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            Training Presentations

                            Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                            Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                            CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                            Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                            Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                            WEB

                            -BAS

                            ED T

                            RAIN

                            ING

                            TRAI

                            NING

                            PRE

                            SENT

                            ATIO

                            NS

                            Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                            httpwwwcmshhsgovMLNProducts

                            21Official CMS Information for Medicare Fee-For-Service Providers

                            Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                            Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                            Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                            Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                            Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                            Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                            Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                            World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                            WEB-BASED TRAINING

                            22

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                            2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                            2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                            2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                            ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                            ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                            ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                            Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                            ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                            SPEC

                            IAL

                            INIT

                            IATI

                            VES

                            httpwwwcmshhsgovMLNProducts

                            23Official CMS Information for Medicare Fee-For-Service Providers

                            General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                            Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                            Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                            2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                            2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                            PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                            2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                            2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                            2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                            SPECIAL INITIATIVES

                            24

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                            2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                            2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                            2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                            PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                            2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                            SPEC

                            IAL

                            INIT

                            IATI

                            VES

                            ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                            httpwwwcmshhsgovMLNProducts

                            25Official CMS Information for Medicare Fee-For-Service Providers

                            Helpful Resources

                            Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                            Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                            Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                            Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                            ICD-10httpwwwcmshhsgovICD10

                            Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                            Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                            Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                            Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                            Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                            Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                            Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                            HELPFUL RESOURCES

                            26

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts26

                            All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                            All Institutional Providerspp 9 14 20 21

                            All Part B Providerspp 11 13

                            All Rural Providerspp 5 7 18 19

                            Ambulance Supplierpp 10-12 17 20

                            Ambulatory Surgical Center (ASC)pp 9 12

                            Chiropractorp 12

                            Clinics Group Practicespp 5 7-9 13

                            Community Mental Health Centerp 14See All Institutional Providers

                            Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                            Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                            Diagnostic Testing Facility Independent (IDTF)pp 7-9

                            Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                            End Stage Renal Disease Facility (ESRD)pp 9 16 20

                            Facilitatorpp 3 5 6

                            Federally Qualified Health Center (FQHC)pp 18-19

                            PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                            Hospicep 14

                            Hospitalpp 3 7-9 12-15 16-20

                            Indian Health Service Facility (IHS)pp 6 14 17

                            Inpatient Rehabilitation Facilitypp 9 15

                            Laboratory Independent Clinical (ICL)pp 7-9

                            Long Term Care Hospital (LTCH)p 15

                            Mammography Centerpp 7-8

                            Medical Billers Coderspp 17 22 23

                            Medicare Dependent Hospitalp 18

                            NPP Non-Physician Practitionerpp 2 5-25

                            Nurse Anesthetist (CRNA)pp 2 5-25

                            Nurse Midwife (CNM)pp 2 5-25

                            Nurse Practitioner (NP)pp 2 5-25

                            Nurse Specialist (CNS)pp 2 5-25

                            Pharmacy PharmacistSee Supplier

                            Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                            PROV

                            IDER

                            INDE

                            X

                            httpwwwcmshhsgovMLNProducts

                            27Official CMS Information for Medicare Fee-For-Service Providers 27

                            Physicianpp 2 5-25

                            Physician Assistant (PA)pp 2 5-25

                            Psychologist Clinical See All Part B Providers

                            Psychiatric HospitalSee Hospital

                            Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                            Rural Health Clinic (RHC)p19See also All Rural Providers

                            Rural Referral Center (RHC)p 19See also All Rural Providers

                            Skilled Nursing Facility (SNF)pp 17 19 21

                            Social Worker Clinicalp 7

                            Sole Community Hospital p 19See All Rural Providers and Hospital

                            Supplierpp 10-11 20

                            Teacherpp 3 5 6

                            X-Ray Facility Portablepp 7-8

                            NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                            PROVIDER INDEX

                            ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                            2828

                            Official CMS Information for Medicare Fee-For-Service Providers

                            httpwwwcmshhsgovMLNProducts

                            SUBJ

                            ECT

                            INDE

                            X

                            Appealsp 10

                            Articlesp 4

                            AV Fistulap 20

                            Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                            Bone Mass Measurementp 9

                            Bookletsp 8

                            Bookmarkspp 6 7 22

                            Brochurespp 9-11

                            Cancer p 9

                            Certificate Of Medical Necessity (CMN)p 20

                            Chiropracticp 12

                            Claims Reviewp 8

                            Clinical Laboratory Improvement Amendments (CLIA)p 9

                            CMS Form 1500pp 13 20

                            Diabetesp10

                            Electronic Prescribing (E-Prescribing)pp 22 25

                            Email Subscription Service p12

                            Emergency Health Servicesp 17

                            SUBJECT INDEXEnrollment Reportingp 13

                            Evaluation And Management Services (EampM) p 2

                            Fact Sheetspp 12-19 22-24

                            Fee Schedulespp 12 16

                            Fraud And Abusepp 16 21

                            Glaucomap 10

                            Guidespp 2 3 25

                            Hospital Acquired Conditions (HAC)p 14

                            Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                            Hospital Outpatient Prospective Payment System (OPPS)p 14

                            ICD-9-CM Diagnosis Coding pp 20 23

                            ICD-10-CM Procedure Codingp 23

                            Immunizationpp 7 9

                            Kidney Dialysis Transplant ESRDpp 2 16 20

                            Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                            Manualsp 9

                            Medicaidp 11

                            httpwwwcmshhsgovMLNProducts

                            29Official CMS Information for Medicare Fee-For-Service Providers

                            SUBJECT INDEX

                            29

                            Medical Reviewp 11

                            Medicarepp 21 25

                            Medicare Learning Network (MLN)pp 4-6 18

                            Medicare Remit Easy Print (MREP)p 10

                            Medicare Secondary Payer (MSP)p 16

                            Outpatient Code Editor (OCE)p 21

                            Overpaymentsp 11

                            Physical Examination (IPPE)pp 7 10

                            Physician Fee Schedule (MPSF)p 16

                            Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                            Podiatry Servicesp 16

                            Power Mobility Devices (PMDs)p 9

                            Practice Managementpp 2-3 7 11-12 16 21

                            Present On Admission (POA)p 17

                            Preventive Servicespp 2 6-11 21

                            Privacyp 16

                            Prospective Payment Systemspp 12-15 17 20

                            Quick Reference Chartspp 7 22 24

                            Rehabilitation Therapy p 17

                            Remittance Advice (RA)p 3

                            Rural Healthpp 5 7 18-19

                            Smoking Cessationp 11

                            SNF Consolidated Billingp 21

                            Special Initiativespp 22-24

                            Spell Of Illnessp 7

                            Swing Bedp 19

                            Telehealth Servicesp 19

                            UB-04pp 14 21

                            Undocumented Aliensp 17

                            Web Addresses Resourcespp 5 25

                            Web-Based Trainingpp 20 21

                            Womenrsquos Healthp 21

                            Official CMS Information for Medicare Fee-For-Service Providers

                            November 2009

                            ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                            R

                            • INTRODUCTION13
                            • TABLE OF CONTENTS
                            • GUIDES
                            • ARTICLES
                            • EDUCATIONAL TOOLS
                            • BOOKLETS
                            • BROCHURES
                            • FACT SHEETS13
                            • TRAINING PRESENTATIONS13
                            • WEB-BASED TRAINING13
                            • SPECIAL INITIATIVES13
                            • HELPFUL RESOURCES13
                            • PROVIDER INDEX
                            • SUBJECT INDEX

                              httpwwwcmshhsgovMLNProducts

                              13Official CMS Information for Medicare Fee-For-Service Providers

                              Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physicians are responsible for maintaining and

                              reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians 2 pages (March 2009) (ICN901643) Suggested For Physicians

                              Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all non-physician practitioners are responsible

                              for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for individual non-physician practitioners 2 pages (March 2009) (ICN901644) Suggested For NPP

                              Fee-For-Service Provider Enrollment Reporting Responsibilities for Physician Group Practices Enrolled in the Medicare ProgramAfter enrolling in the Medicare Program all physician group practices

                              are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor This fact sheet outlines such reportable events for physicians group practices 2 pages (March 2009) (ICN901645) Suggested For Physician Group Practices

                              Form CMS 1500 at A Glance This fact sheet explains the CMS Form 1500 which is the standard paper claim form used by health care professionals to bill for Medicare Part B services It includes background information and

                              a descriptive crosswalk of fields in the paper versus the electronic form 5 pages (April 2008) (ICN006976) Suggested For All Medicare Part B Providers (except hospitals and institutional Part B claims paid by DRG)

                              Guidelines for Teaching Physicians Interns and Residents This fact sheet provides information about payment for physician services in teaching settings general documentation guidelines and evaluation and management

                              documentation guidelines 4 pages (July 2008) (ICN 006347) (Last reviewed September 2009)Suggested For Hospitals Interns Physicians Residents

                              Home Health Prospective Payment System (HH PPS)This fact sheet provides information about coverage of home health services and elements of the Home Health Prospective Payment System 4 pages

                              (December 2008) (ICN006816) Suggested For Home Health Agencies NPP Physicians

                              FACT SHEETS

                              14

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts

                              Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                              Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                              (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                              Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                              fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                              Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                              4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                              Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                              information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                              Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                              the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                              Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                              the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                              FACT

                              SHE

                              ETS

                              httpwwwcmshhsgovMLNProducts

                              15Official CMS Information for Medicare Fee-For-Service Providers

                              Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                              and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                              Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                              4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                              Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                              9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                              Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                              System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                              Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                              Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                              Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                              8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                              FACT SHEETS

                              16

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts

                              Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                              Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                              on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                              Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                              Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                              Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                              Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                              Downloadable only Suggested For NPP Physicians

                              Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                              settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                              Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                              separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                              ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                              FACT

                              SHE

                              ETS

                              httpwwwcmshhsgovMLNProducts

                              17Official CMS Information for Medicare Fee-For-Service Providers

                              Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                              of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                              Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                              of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                              Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                              as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                              Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                              FACT SHEETS

                              Official CMS Information for Medicare Fee-For-Service Providers

                              18

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts

                              Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                              Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                              and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                              Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                              Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                              Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                              Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                              payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                              Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                              Downloadable only Suggested For Hospitals

                              Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                              Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                              FACT

                              SHE

                              ETS

                              httpwwwcmshhsgovMLNProducts

                              19Official CMS Information for Medicare Fee-For-Service Providers

                              Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                              Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                              Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                              Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                              Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                              or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                              Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                              4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                              Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                              sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                              FACT SHEETS

                              20

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts

                              Training Presentations

                              Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                              Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                              CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                              Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                              Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                              WEB

                              -BAS

                              ED T

                              RAIN

                              ING

                              TRAI

                              NING

                              PRE

                              SENT

                              ATIO

                              NS

                              Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                              httpwwwcmshhsgovMLNProducts

                              21Official CMS Information for Medicare Fee-For-Service Providers

                              Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                              Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                              Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                              Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                              Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                              Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                              Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                              World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                              WEB-BASED TRAINING

                              22

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts

                              Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                              2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                              2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                              2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                              ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                              ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                              ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                              Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                              ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                              SPEC

                              IAL

                              INIT

                              IATI

                              VES

                              httpwwwcmshhsgovMLNProducts

                              23Official CMS Information for Medicare Fee-For-Service Providers

                              General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                              Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                              Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                              2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                              2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                              PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                              2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                              2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                              2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                              SPECIAL INITIATIVES

                              24

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts

                              Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                              2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                              2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                              2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                              PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                              2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                              SPEC

                              IAL

                              INIT

                              IATI

                              VES

                              ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                              httpwwwcmshhsgovMLNProducts

                              25Official CMS Information for Medicare Fee-For-Service Providers

                              Helpful Resources

                              Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                              Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                              Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                              Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                              ICD-10httpwwwcmshhsgovICD10

                              Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                              Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                              Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                              Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                              Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                              Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                              Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                              HELPFUL RESOURCES

                              26

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts26

                              All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                              All Institutional Providerspp 9 14 20 21

                              All Part B Providerspp 11 13

                              All Rural Providerspp 5 7 18 19

                              Ambulance Supplierpp 10-12 17 20

                              Ambulatory Surgical Center (ASC)pp 9 12

                              Chiropractorp 12

                              Clinics Group Practicespp 5 7-9 13

                              Community Mental Health Centerp 14See All Institutional Providers

                              Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                              Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                              Diagnostic Testing Facility Independent (IDTF)pp 7-9

                              Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                              End Stage Renal Disease Facility (ESRD)pp 9 16 20

                              Facilitatorpp 3 5 6

                              Federally Qualified Health Center (FQHC)pp 18-19

                              PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                              Hospicep 14

                              Hospitalpp 3 7-9 12-15 16-20

                              Indian Health Service Facility (IHS)pp 6 14 17

                              Inpatient Rehabilitation Facilitypp 9 15

                              Laboratory Independent Clinical (ICL)pp 7-9

                              Long Term Care Hospital (LTCH)p 15

                              Mammography Centerpp 7-8

                              Medical Billers Coderspp 17 22 23

                              Medicare Dependent Hospitalp 18

                              NPP Non-Physician Practitionerpp 2 5-25

                              Nurse Anesthetist (CRNA)pp 2 5-25

                              Nurse Midwife (CNM)pp 2 5-25

                              Nurse Practitioner (NP)pp 2 5-25

                              Nurse Specialist (CNS)pp 2 5-25

                              Pharmacy PharmacistSee Supplier

                              Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                              PROV

                              IDER

                              INDE

                              X

                              httpwwwcmshhsgovMLNProducts

                              27Official CMS Information for Medicare Fee-For-Service Providers 27

                              Physicianpp 2 5-25

                              Physician Assistant (PA)pp 2 5-25

                              Psychologist Clinical See All Part B Providers

                              Psychiatric HospitalSee Hospital

                              Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                              Rural Health Clinic (RHC)p19See also All Rural Providers

                              Rural Referral Center (RHC)p 19See also All Rural Providers

                              Skilled Nursing Facility (SNF)pp 17 19 21

                              Social Worker Clinicalp 7

                              Sole Community Hospital p 19See All Rural Providers and Hospital

                              Supplierpp 10-11 20

                              Teacherpp 3 5 6

                              X-Ray Facility Portablepp 7-8

                              NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                              PROVIDER INDEX

                              ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                              2828

                              Official CMS Information for Medicare Fee-For-Service Providers

                              httpwwwcmshhsgovMLNProducts

                              SUBJ

                              ECT

                              INDE

                              X

                              Appealsp 10

                              Articlesp 4

                              AV Fistulap 20

                              Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                              Bone Mass Measurementp 9

                              Bookletsp 8

                              Bookmarkspp 6 7 22

                              Brochurespp 9-11

                              Cancer p 9

                              Certificate Of Medical Necessity (CMN)p 20

                              Chiropracticp 12

                              Claims Reviewp 8

                              Clinical Laboratory Improvement Amendments (CLIA)p 9

                              CMS Form 1500pp 13 20

                              Diabetesp10

                              Electronic Prescribing (E-Prescribing)pp 22 25

                              Email Subscription Service p12

                              Emergency Health Servicesp 17

                              SUBJECT INDEXEnrollment Reportingp 13

                              Evaluation And Management Services (EampM) p 2

                              Fact Sheetspp 12-19 22-24

                              Fee Schedulespp 12 16

                              Fraud And Abusepp 16 21

                              Glaucomap 10

                              Guidespp 2 3 25

                              Hospital Acquired Conditions (HAC)p 14

                              Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                              Hospital Outpatient Prospective Payment System (OPPS)p 14

                              ICD-9-CM Diagnosis Coding pp 20 23

                              ICD-10-CM Procedure Codingp 23

                              Immunizationpp 7 9

                              Kidney Dialysis Transplant ESRDpp 2 16 20

                              Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                              Manualsp 9

                              Medicaidp 11

                              httpwwwcmshhsgovMLNProducts

                              29Official CMS Information for Medicare Fee-For-Service Providers

                              SUBJECT INDEX

                              29

                              Medical Reviewp 11

                              Medicarepp 21 25

                              Medicare Learning Network (MLN)pp 4-6 18

                              Medicare Remit Easy Print (MREP)p 10

                              Medicare Secondary Payer (MSP)p 16

                              Outpatient Code Editor (OCE)p 21

                              Overpaymentsp 11

                              Physical Examination (IPPE)pp 7 10

                              Physician Fee Schedule (MPSF)p 16

                              Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                              Podiatry Servicesp 16

                              Power Mobility Devices (PMDs)p 9

                              Practice Managementpp 2-3 7 11-12 16 21

                              Present On Admission (POA)p 17

                              Preventive Servicespp 2 6-11 21

                              Privacyp 16

                              Prospective Payment Systemspp 12-15 17 20

                              Quick Reference Chartspp 7 22 24

                              Rehabilitation Therapy p 17

                              Remittance Advice (RA)p 3

                              Rural Healthpp 5 7 18-19

                              Smoking Cessationp 11

                              SNF Consolidated Billingp 21

                              Special Initiativespp 22-24

                              Spell Of Illnessp 7

                              Swing Bedp 19

                              Telehealth Servicesp 19

                              UB-04pp 14 21

                              Undocumented Aliensp 17

                              Web Addresses Resourcespp 5 25

                              Web-Based Trainingpp 20 21

                              Womenrsquos Healthp 21

                              Official CMS Information for Medicare Fee-For-Service Providers

                              November 2009

                              ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                              R

                              • INTRODUCTION13
                              • TABLE OF CONTENTS
                              • GUIDES
                              • ARTICLES
                              • EDUCATIONAL TOOLS
                              • BOOKLETS
                              • BROCHURES
                              • FACT SHEETS13
                              • TRAINING PRESENTATIONS13
                              • WEB-BASED TRAINING13
                              • SPECIAL INITIATIVES13
                              • HELPFUL RESOURCES13
                              • PROVIDER INDEX
                              • SUBJECT INDEX

                                14

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts

                                Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                Hospice Payment System This fact sheet provides general information about the Medicare hospice benefit including coverage of hospice services certification requirements election periods and how payment rates are set 4 pages

                                (January 2009) (ICN006817) Suggested For Hospice NPP Physicians Other Included Services

                                Hospital-Acquired Conditions (HAC) The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payment for certain Hospital Acquired Conditions (HACs) This

                                fact sheet lists all 10 categories of HAC to help providers learn more about the HAC program 3 pages (October 2008) (ICN901045) Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                                Hospital Outpatient Prospective Payment System (OPPS)This fact sheet provides general information about the Hospital Outpatient Prospective Payment System ambulatory payment classifications and how payment rates are set

                                4 pages (January 2009) (ICN006820) Suggested For Community Mental Health Centers Home Health Agencies NPP Hospitals Physicians

                                Implementation of the UB-04 This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers who are excluded from the mandatory electronic claims submission It includes background

                                information the transition period and a crosswalk 8 pages (February 2009) (ICN006926) Formats Available Downloadable only Suggested For All Medicare Institutional Providers

                                Information and Education Resources for Medicare Fee-For-Service (FFS) Health Care Professionals This fact sheet is intended to notify Medicare FFS physicians and other health care professionals about

                                the information and educational resources that the Centers for Medicare amp Medicaid Services (CMS) has developed to help meet their Medicare business needs 2 pages (June 2006) (ICN006489)Suggested For NPP Physicians

                                Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)This fact sheet provides information about the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) how payment rates are set and

                                the Rate Year 2010 update to the IPF PPS 4 pages (May 2009) (ICN006839) Suggested For CAH Hospitals NPP Physicians Psychiatric Hospitals

                                FACT

                                SHE

                                ETS

                                httpwwwcmshhsgovMLNProducts

                                15Official CMS Information for Medicare Fee-For-Service Providers

                                Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                                and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                                Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                                4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                                9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                                System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                                Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                                8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                FACT SHEETS

                                16

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts

                                Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                                on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                                Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                                Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                                Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                                Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                                Downloadable only Suggested For NPP Physicians

                                Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                                settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                                Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                                separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                                ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                                FACT

                                SHE

                                ETS

                                httpwwwcmshhsgovMLNProducts

                                17Official CMS Information for Medicare Fee-For-Service Providers

                                Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                                of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                                Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                                of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                                Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                                as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                                Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                                FACT SHEETS

                                Official CMS Information for Medicare Fee-For-Service Providers

                                18

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts

                                Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                                and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                                Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                                Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                                Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                                Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                                payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                                Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                                Downloadable only Suggested For Hospitals

                                Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                                Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                                FACT

                                SHE

                                ETS

                                httpwwwcmshhsgovMLNProducts

                                19Official CMS Information for Medicare Fee-For-Service Providers

                                Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                                Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                                or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                                Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                                4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                                sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                FACT SHEETS

                                20

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts

                                Training Presentations

                                Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                                Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                                CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                                Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                                Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                                WEB

                                -BAS

                                ED T

                                RAIN

                                ING

                                TRAI

                                NING

                                PRE

                                SENT

                                ATIO

                                NS

                                Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                                httpwwwcmshhsgovMLNProducts

                                21Official CMS Information for Medicare Fee-For-Service Providers

                                Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                WEB-BASED TRAINING

                                22

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts

                                Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                SPEC

                                IAL

                                INIT

                                IATI

                                VES

                                httpwwwcmshhsgovMLNProducts

                                23Official CMS Information for Medicare Fee-For-Service Providers

                                General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                SPECIAL INITIATIVES

                                24

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts

                                Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                SPEC

                                IAL

                                INIT

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                                ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                httpwwwcmshhsgovMLNProducts

                                25Official CMS Information for Medicare Fee-For-Service Providers

                                Helpful Resources

                                Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                ICD-10httpwwwcmshhsgovICD10

                                Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                HELPFUL RESOURCES

                                26

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts26

                                All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                All Institutional Providerspp 9 14 20 21

                                All Part B Providerspp 11 13

                                All Rural Providerspp 5 7 18 19

                                Ambulance Supplierpp 10-12 17 20

                                Ambulatory Surgical Center (ASC)pp 9 12

                                Chiropractorp 12

                                Clinics Group Practicespp 5 7-9 13

                                Community Mental Health Centerp 14See All Institutional Providers

                                Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                Facilitatorpp 3 5 6

                                Federally Qualified Health Center (FQHC)pp 18-19

                                PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                Hospicep 14

                                Hospitalpp 3 7-9 12-15 16-20

                                Indian Health Service Facility (IHS)pp 6 14 17

                                Inpatient Rehabilitation Facilitypp 9 15

                                Laboratory Independent Clinical (ICL)pp 7-9

                                Long Term Care Hospital (LTCH)p 15

                                Mammography Centerpp 7-8

                                Medical Billers Coderspp 17 22 23

                                Medicare Dependent Hospitalp 18

                                NPP Non-Physician Practitionerpp 2 5-25

                                Nurse Anesthetist (CRNA)pp 2 5-25

                                Nurse Midwife (CNM)pp 2 5-25

                                Nurse Practitioner (NP)pp 2 5-25

                                Nurse Specialist (CNS)pp 2 5-25

                                Pharmacy PharmacistSee Supplier

                                Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                PROV

                                IDER

                                INDE

                                X

                                httpwwwcmshhsgovMLNProducts

                                27Official CMS Information for Medicare Fee-For-Service Providers 27

                                Physicianpp 2 5-25

                                Physician Assistant (PA)pp 2 5-25

                                Psychologist Clinical See All Part B Providers

                                Psychiatric HospitalSee Hospital

                                Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                Rural Health Clinic (RHC)p19See also All Rural Providers

                                Rural Referral Center (RHC)p 19See also All Rural Providers

                                Skilled Nursing Facility (SNF)pp 17 19 21

                                Social Worker Clinicalp 7

                                Sole Community Hospital p 19See All Rural Providers and Hospital

                                Supplierpp 10-11 20

                                Teacherpp 3 5 6

                                X-Ray Facility Portablepp 7-8

                                NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                PROVIDER INDEX

                                ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                2828

                                Official CMS Information for Medicare Fee-For-Service Providers

                                httpwwwcmshhsgovMLNProducts

                                SUBJ

                                ECT

                                INDE

                                X

                                Appealsp 10

                                Articlesp 4

                                AV Fistulap 20

                                Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                Bone Mass Measurementp 9

                                Bookletsp 8

                                Bookmarkspp 6 7 22

                                Brochurespp 9-11

                                Cancer p 9

                                Certificate Of Medical Necessity (CMN)p 20

                                Chiropracticp 12

                                Claims Reviewp 8

                                Clinical Laboratory Improvement Amendments (CLIA)p 9

                                CMS Form 1500pp 13 20

                                Diabetesp10

                                Electronic Prescribing (E-Prescribing)pp 22 25

                                Email Subscription Service p12

                                Emergency Health Servicesp 17

                                SUBJECT INDEXEnrollment Reportingp 13

                                Evaluation And Management Services (EampM) p 2

                                Fact Sheetspp 12-19 22-24

                                Fee Schedulespp 12 16

                                Fraud And Abusepp 16 21

                                Glaucomap 10

                                Guidespp 2 3 25

                                Hospital Acquired Conditions (HAC)p 14

                                Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                Hospital Outpatient Prospective Payment System (OPPS)p 14

                                ICD-9-CM Diagnosis Coding pp 20 23

                                ICD-10-CM Procedure Codingp 23

                                Immunizationpp 7 9

                                Kidney Dialysis Transplant ESRDpp 2 16 20

                                Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                Manualsp 9

                                Medicaidp 11

                                httpwwwcmshhsgovMLNProducts

                                29Official CMS Information for Medicare Fee-For-Service Providers

                                SUBJECT INDEX

                                29

                                Medical Reviewp 11

                                Medicarepp 21 25

                                Medicare Learning Network (MLN)pp 4-6 18

                                Medicare Remit Easy Print (MREP)p 10

                                Medicare Secondary Payer (MSP)p 16

                                Outpatient Code Editor (OCE)p 21

                                Overpaymentsp 11

                                Physical Examination (IPPE)pp 7 10

                                Physician Fee Schedule (MPSF)p 16

                                Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                Podiatry Servicesp 16

                                Power Mobility Devices (PMDs)p 9

                                Practice Managementpp 2-3 7 11-12 16 21

                                Present On Admission (POA)p 17

                                Preventive Servicespp 2 6-11 21

                                Privacyp 16

                                Prospective Payment Systemspp 12-15 17 20

                                Quick Reference Chartspp 7 22 24

                                Rehabilitation Therapy p 17

                                Remittance Advice (RA)p 3

                                Rural Healthpp 5 7 18-19

                                Smoking Cessationp 11

                                SNF Consolidated Billingp 21

                                Special Initiativespp 22-24

                                Spell Of Illnessp 7

                                Swing Bedp 19

                                Telehealth Servicesp 19

                                UB-04pp 14 21

                                Undocumented Aliensp 17

                                Web Addresses Resourcespp 5 25

                                Web-Based Trainingpp 20 21

                                Womenrsquos Healthp 21

                                Official CMS Information for Medicare Fee-For-Service Providers

                                November 2009

                                ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                R

                                • INTRODUCTION13
                                • TABLE OF CONTENTS
                                • GUIDES
                                • ARTICLES
                                • EDUCATIONAL TOOLS
                                • BOOKLETS
                                • BROCHURES
                                • FACT SHEETS13
                                • TRAINING PRESENTATIONS13
                                • WEB-BASED TRAINING13
                                • SPECIAL INITIATIVES13
                                • HELPFUL RESOURCES13
                                • PROVIDER INDEX
                                • SUBJECT INDEX

                                  httpwwwcmshhsgovMLNProducts

                                  15Official CMS Information for Medicare Fee-For-Service Providers

                                  Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) This fact sheet provides information about Inpatient Rehabilitation Facility Prospective Payment System rates classification criterion

                                  and reasonable and necessary criteria 4 pages (August 2009) (ICN006847) Suggested For Hospitals Inpatient Rehabilitation Facilities NPP Physicians

                                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Updated Final Rule This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                                  4 pages (January 2009) (ICN006393) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Short-Stay Outliers This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                                  9 pages (January 2009) (ICN006394) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Interrupted Stay This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital (LTCH) Prospective Payment

                                  System 8 pages (January 2009) (ICN006395) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                  Long Term Care Hospital Prospective Payment System (LTCH PPS) Payment Adjustment Policy This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital

                                  Prospective Payment System 6 pages (January 2009) (ICN006956) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                  Long Term Care Hospital Prospective Payment System (LTCH PPS) High Cost Outlier This fact sheet helps Medicare Part A providers better understand the various aspects of the Long Term Care Hospital Prospective Payment System

                                  8 pages (January 2009) (ICN006396) Formats Available Downloadable only Suggested For Hospitals LTCH NPP Physicians

                                  FACT SHEETS

                                  16

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  httpwwwcmshhsgovMLNProducts

                                  Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                  Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                                  on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                                  Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                                  Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                                  Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                                  Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                                  Downloadable only Suggested For NPP Physicians

                                  Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                                  settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                                  Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                                  separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                                  ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                                  FACT

                                  SHE

                                  ETS

                                  httpwwwcmshhsgovMLNProducts

                                  17Official CMS Information for Medicare Fee-For-Service Providers

                                  Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                                  of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                                  Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                                  of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                                  Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                                  as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                                  Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                                  FACT SHEETS

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  18

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  httpwwwcmshhsgovMLNProducts

                                  Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                  Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                                  and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                                  Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                                  Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                                  Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                                  Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                                  payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                                  Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                                  Downloadable only Suggested For Hospitals

                                  Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                                  Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                                  FACT

                                  SHE

                                  ETS

                                  httpwwwcmshhsgovMLNProducts

                                  19Official CMS Information for Medicare Fee-For-Service Providers

                                  Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                                  Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                  Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                  Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                  Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                                  or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                                  Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                                  4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                  Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                                  sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                  FACT SHEETS

                                  20

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  httpwwwcmshhsgovMLNProducts

                                  Training Presentations

                                  Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                                  Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                                  CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                                  Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                                  Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                                  WEB

                                  -BAS

                                  ED T

                                  RAIN

                                  ING

                                  TRAI

                                  NING

                                  PRE

                                  SENT

                                  ATIO

                                  NS

                                  Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                                  httpwwwcmshhsgovMLNProducts

                                  21Official CMS Information for Medicare Fee-For-Service Providers

                                  Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                  Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                  Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                  Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                  Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                  Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                  Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                  World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                  WEB-BASED TRAINING

                                  22

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  httpwwwcmshhsgovMLNProducts

                                  Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                  2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                  2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                  2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                  ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                  ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                  ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                  Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                  ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                  SPEC

                                  IAL

                                  INIT

                                  IATI

                                  VES

                                  httpwwwcmshhsgovMLNProducts

                                  23Official CMS Information for Medicare Fee-For-Service Providers

                                  General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                  Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                  Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                  2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                  2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                  PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                  2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                  2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                  2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                  SPECIAL INITIATIVES

                                  24

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  httpwwwcmshhsgovMLNProducts

                                  Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                  2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                  2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                  2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                  PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                  2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                  SPEC

                                  IAL

                                  INIT

                                  IATI

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                                  ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                  httpwwwcmshhsgovMLNProducts

                                  25Official CMS Information for Medicare Fee-For-Service Providers

                                  Helpful Resources

                                  Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                  Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                  Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                  Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                  ICD-10httpwwwcmshhsgovICD10

                                  Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                  Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                  Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                  Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                  Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                  Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                  Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                  HELPFUL RESOURCES

                                  26

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  httpwwwcmshhsgovMLNProducts26

                                  All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                  All Institutional Providerspp 9 14 20 21

                                  All Part B Providerspp 11 13

                                  All Rural Providerspp 5 7 18 19

                                  Ambulance Supplierpp 10-12 17 20

                                  Ambulatory Surgical Center (ASC)pp 9 12

                                  Chiropractorp 12

                                  Clinics Group Practicespp 5 7-9 13

                                  Community Mental Health Centerp 14See All Institutional Providers

                                  Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                  Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                  Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                  Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                  End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                  Facilitatorpp 3 5 6

                                  Federally Qualified Health Center (FQHC)pp 18-19

                                  PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                  Hospicep 14

                                  Hospitalpp 3 7-9 12-15 16-20

                                  Indian Health Service Facility (IHS)pp 6 14 17

                                  Inpatient Rehabilitation Facilitypp 9 15

                                  Laboratory Independent Clinical (ICL)pp 7-9

                                  Long Term Care Hospital (LTCH)p 15

                                  Mammography Centerpp 7-8

                                  Medical Billers Coderspp 17 22 23

                                  Medicare Dependent Hospitalp 18

                                  NPP Non-Physician Practitionerpp 2 5-25

                                  Nurse Anesthetist (CRNA)pp 2 5-25

                                  Nurse Midwife (CNM)pp 2 5-25

                                  Nurse Practitioner (NP)pp 2 5-25

                                  Nurse Specialist (CNS)pp 2 5-25

                                  Pharmacy PharmacistSee Supplier

                                  Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                  PROV

                                  IDER

                                  INDE

                                  X

                                  httpwwwcmshhsgovMLNProducts

                                  27Official CMS Information for Medicare Fee-For-Service Providers 27

                                  Physicianpp 2 5-25

                                  Physician Assistant (PA)pp 2 5-25

                                  Psychologist Clinical See All Part B Providers

                                  Psychiatric HospitalSee Hospital

                                  Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                  Rural Health Clinic (RHC)p19See also All Rural Providers

                                  Rural Referral Center (RHC)p 19See also All Rural Providers

                                  Skilled Nursing Facility (SNF)pp 17 19 21

                                  Social Worker Clinicalp 7

                                  Sole Community Hospital p 19See All Rural Providers and Hospital

                                  Supplierpp 10-11 20

                                  Teacherpp 3 5 6

                                  X-Ray Facility Portablepp 7-8

                                  NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                  PROVIDER INDEX

                                  ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                  2828

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  httpwwwcmshhsgovMLNProducts

                                  SUBJ

                                  ECT

                                  INDE

                                  X

                                  Appealsp 10

                                  Articlesp 4

                                  AV Fistulap 20

                                  Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                  Bone Mass Measurementp 9

                                  Bookletsp 8

                                  Bookmarkspp 6 7 22

                                  Brochurespp 9-11

                                  Cancer p 9

                                  Certificate Of Medical Necessity (CMN)p 20

                                  Chiropracticp 12

                                  Claims Reviewp 8

                                  Clinical Laboratory Improvement Amendments (CLIA)p 9

                                  CMS Form 1500pp 13 20

                                  Diabetesp10

                                  Electronic Prescribing (E-Prescribing)pp 22 25

                                  Email Subscription Service p12

                                  Emergency Health Servicesp 17

                                  SUBJECT INDEXEnrollment Reportingp 13

                                  Evaluation And Management Services (EampM) p 2

                                  Fact Sheetspp 12-19 22-24

                                  Fee Schedulespp 12 16

                                  Fraud And Abusepp 16 21

                                  Glaucomap 10

                                  Guidespp 2 3 25

                                  Hospital Acquired Conditions (HAC)p 14

                                  Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                  Hospital Outpatient Prospective Payment System (OPPS)p 14

                                  ICD-9-CM Diagnosis Coding pp 20 23

                                  ICD-10-CM Procedure Codingp 23

                                  Immunizationpp 7 9

                                  Kidney Dialysis Transplant ESRDpp 2 16 20

                                  Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                  Manualsp 9

                                  Medicaidp 11

                                  httpwwwcmshhsgovMLNProducts

                                  29Official CMS Information for Medicare Fee-For-Service Providers

                                  SUBJECT INDEX

                                  29

                                  Medical Reviewp 11

                                  Medicarepp 21 25

                                  Medicare Learning Network (MLN)pp 4-6 18

                                  Medicare Remit Easy Print (MREP)p 10

                                  Medicare Secondary Payer (MSP)p 16

                                  Outpatient Code Editor (OCE)p 21

                                  Overpaymentsp 11

                                  Physical Examination (IPPE)pp 7 10

                                  Physician Fee Schedule (MPSF)p 16

                                  Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                  Podiatry Servicesp 16

                                  Power Mobility Devices (PMDs)p 9

                                  Practice Managementpp 2-3 7 11-12 16 21

                                  Present On Admission (POA)p 17

                                  Preventive Servicespp 2 6-11 21

                                  Privacyp 16

                                  Prospective Payment Systemspp 12-15 17 20

                                  Quick Reference Chartspp 7 22 24

                                  Rehabilitation Therapy p 17

                                  Remittance Advice (RA)p 3

                                  Rural Healthpp 5 7 18-19

                                  Smoking Cessationp 11

                                  SNF Consolidated Billingp 21

                                  Special Initiativespp 22-24

                                  Spell Of Illnessp 7

                                  Swing Bedp 19

                                  Telehealth Servicesp 19

                                  UB-04pp 14 21

                                  Undocumented Aliensp 17

                                  Web Addresses Resourcespp 5 25

                                  Web-Based Trainingpp 20 21

                                  Womenrsquos Healthp 21

                                  Official CMS Information for Medicare Fee-For-Service Providers

                                  November 2009

                                  ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                  R

                                  • INTRODUCTION13
                                  • TABLE OF CONTENTS
                                  • GUIDES
                                  • ARTICLES
                                  • EDUCATIONAL TOOLS
                                  • BOOKLETS
                                  • BROCHURES
                                  • FACT SHEETS13
                                  • TRAINING PRESENTATIONS13
                                  • WEB-BASED TRAINING13
                                  • SPECIAL INITIATIVES13
                                  • HELPFUL RESOURCES13
                                  • PROVIDER INDEX
                                  • SUBJECT INDEX

                                    16

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    httpwwwcmshhsgovMLNProducts

                                    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                    Medical Privacy of Protected Health Information This fact sheet contains resources and information regarding the HIPAA Privacy Rule and how this applies to customary health care practices and other information

                                    on the HHS HIPAA web page 2 pages (June 2009) (ICN006942) Formats Available Downloadable only Suggested For All Medicare Providers

                                    Medicare Fraud and Abuse This fact sheet directs you to a number of sources of information pertaining to Medicare Fraud and Abuse and helps you understand what to do if you suspect or become aware of incidents of potential

                                    Medicare fraud or abuse 4 pages (January 2009) (ICN006827)Suggested For All Medicare Providers

                                    Medicare Physician Fee Schedule (MPFS)This fact sheet provides general information about the Medicare Physician Fee Schedule 4 pages (January 2009) (ICN006814) Suggested For All Medicare Fee-For-Service Providers

                                    Medicare Podiatry Services This fact sheet is intended for use as an educational tool for Medicare as it relates to Podiatry coverage and billing guidelines 5 pages (March 2008) (ICN006948) Formats Available

                                    Downloadable only Suggested For NPP Physicians

                                    Medicare Secondary Payer (MSP) This fact sheet provides a general overview of the Medicare Secondary Payer provisions for individuals involved in the admission and billing procedures at provider physician and other supplier

                                    settings 6 pages (April 2009) (ICN006903) Suggested For DMEPOS NPP Other Suppliers Physicians

                                    Outpatient Maintenance Dialysis End-Stage Renal Disease (ESRD)This fact sheet provides general information about Outpatient Maintenance Dialysis for End-Stage Renal Disease the composite payment rate system and

                                    separately billable items and services 4 pages (February 2009) (ICN006469) Suggested For ESRD Facilities NPP Physicians

                                    ldquoThe lsquoSuggested Forrsquo section after each product helps highlight products of importance to merdquo ndash CMS Website User

                                    FACT

                                    SHE

                                    ETS

                                    httpwwwcmshhsgovMLNProducts

                                    17Official CMS Information for Medicare Fee-For-Service Providers

                                    Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                                    of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                                    Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                                    of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                                    Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                                    as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                                    Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                                    FACT SHEETS

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    18

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    httpwwwcmshhsgovMLNProducts

                                    Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                    Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                                    and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                                    Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                                    Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                                    Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                                    Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                                    payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                                    Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                                    Downloadable only Suggested For Hospitals

                                    Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                                    Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                                    FACT

                                    SHE

                                    ETS

                                    httpwwwcmshhsgovMLNProducts

                                    19Official CMS Information for Medicare Fee-For-Service Providers

                                    Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                                    Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                    Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                    Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                    Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                                    or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                                    Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                                    4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                    Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                                    sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                    FACT SHEETS

                                    20

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    httpwwwcmshhsgovMLNProducts

                                    Training Presentations

                                    Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                                    Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                                    CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                                    Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                                    Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                                    WEB

                                    -BAS

                                    ED T

                                    RAIN

                                    ING

                                    TRAI

                                    NING

                                    PRE

                                    SENT

                                    ATIO

                                    NS

                                    Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                                    httpwwwcmshhsgovMLNProducts

                                    21Official CMS Information for Medicare Fee-For-Service Providers

                                    Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                    Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                    Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                    Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                    Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                    Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                    Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                    World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                    WEB-BASED TRAINING

                                    22

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    httpwwwcmshhsgovMLNProducts

                                    Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                    2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                    2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                    2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                    ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                    ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                    ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                    Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                    ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                    SPEC

                                    IAL

                                    INIT

                                    IATI

                                    VES

                                    httpwwwcmshhsgovMLNProducts

                                    23Official CMS Information for Medicare Fee-For-Service Providers

                                    General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                    Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                    Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                    2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                    2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                    PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                    2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                    2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                    2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                    SPECIAL INITIATIVES

                                    24

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    httpwwwcmshhsgovMLNProducts

                                    Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                    2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                    2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                    2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                    PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                    2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                    SPEC

                                    IAL

                                    INIT

                                    IATI

                                    VES

                                    ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                    httpwwwcmshhsgovMLNProducts

                                    25Official CMS Information for Medicare Fee-For-Service Providers

                                    Helpful Resources

                                    Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                    Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                    Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                    Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                    ICD-10httpwwwcmshhsgovICD10

                                    Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                    Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                    Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                    Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                    Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                    Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                    Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                    HELPFUL RESOURCES

                                    26

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    httpwwwcmshhsgovMLNProducts26

                                    All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                    All Institutional Providerspp 9 14 20 21

                                    All Part B Providerspp 11 13

                                    All Rural Providerspp 5 7 18 19

                                    Ambulance Supplierpp 10-12 17 20

                                    Ambulatory Surgical Center (ASC)pp 9 12

                                    Chiropractorp 12

                                    Clinics Group Practicespp 5 7-9 13

                                    Community Mental Health Centerp 14See All Institutional Providers

                                    Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                    Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                    Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                    Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                    End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                    Facilitatorpp 3 5 6

                                    Federally Qualified Health Center (FQHC)pp 18-19

                                    PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                    Hospicep 14

                                    Hospitalpp 3 7-9 12-15 16-20

                                    Indian Health Service Facility (IHS)pp 6 14 17

                                    Inpatient Rehabilitation Facilitypp 9 15

                                    Laboratory Independent Clinical (ICL)pp 7-9

                                    Long Term Care Hospital (LTCH)p 15

                                    Mammography Centerpp 7-8

                                    Medical Billers Coderspp 17 22 23

                                    Medicare Dependent Hospitalp 18

                                    NPP Non-Physician Practitionerpp 2 5-25

                                    Nurse Anesthetist (CRNA)pp 2 5-25

                                    Nurse Midwife (CNM)pp 2 5-25

                                    Nurse Practitioner (NP)pp 2 5-25

                                    Nurse Specialist (CNS)pp 2 5-25

                                    Pharmacy PharmacistSee Supplier

                                    Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                    PROV

                                    IDER

                                    INDE

                                    X

                                    httpwwwcmshhsgovMLNProducts

                                    27Official CMS Information for Medicare Fee-For-Service Providers 27

                                    Physicianpp 2 5-25

                                    Physician Assistant (PA)pp 2 5-25

                                    Psychologist Clinical See All Part B Providers

                                    Psychiatric HospitalSee Hospital

                                    Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                    Rural Health Clinic (RHC)p19See also All Rural Providers

                                    Rural Referral Center (RHC)p 19See also All Rural Providers

                                    Skilled Nursing Facility (SNF)pp 17 19 21

                                    Social Worker Clinicalp 7

                                    Sole Community Hospital p 19See All Rural Providers and Hospital

                                    Supplierpp 10-11 20

                                    Teacherpp 3 5 6

                                    X-Ray Facility Portablepp 7-8

                                    NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                    PROVIDER INDEX

                                    ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                    2828

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    httpwwwcmshhsgovMLNProducts

                                    SUBJ

                                    ECT

                                    INDE

                                    X

                                    Appealsp 10

                                    Articlesp 4

                                    AV Fistulap 20

                                    Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                    Bone Mass Measurementp 9

                                    Bookletsp 8

                                    Bookmarkspp 6 7 22

                                    Brochurespp 9-11

                                    Cancer p 9

                                    Certificate Of Medical Necessity (CMN)p 20

                                    Chiropracticp 12

                                    Claims Reviewp 8

                                    Clinical Laboratory Improvement Amendments (CLIA)p 9

                                    CMS Form 1500pp 13 20

                                    Diabetesp10

                                    Electronic Prescribing (E-Prescribing)pp 22 25

                                    Email Subscription Service p12

                                    Emergency Health Servicesp 17

                                    SUBJECT INDEXEnrollment Reportingp 13

                                    Evaluation And Management Services (EampM) p 2

                                    Fact Sheetspp 12-19 22-24

                                    Fee Schedulespp 12 16

                                    Fraud And Abusepp 16 21

                                    Glaucomap 10

                                    Guidespp 2 3 25

                                    Hospital Acquired Conditions (HAC)p 14

                                    Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                    Hospital Outpatient Prospective Payment System (OPPS)p 14

                                    ICD-9-CM Diagnosis Coding pp 20 23

                                    ICD-10-CM Procedure Codingp 23

                                    Immunizationpp 7 9

                                    Kidney Dialysis Transplant ESRDpp 2 16 20

                                    Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                    Manualsp 9

                                    Medicaidp 11

                                    httpwwwcmshhsgovMLNProducts

                                    29Official CMS Information for Medicare Fee-For-Service Providers

                                    SUBJECT INDEX

                                    29

                                    Medical Reviewp 11

                                    Medicarepp 21 25

                                    Medicare Learning Network (MLN)pp 4-6 18

                                    Medicare Remit Easy Print (MREP)p 10

                                    Medicare Secondary Payer (MSP)p 16

                                    Outpatient Code Editor (OCE)p 21

                                    Overpaymentsp 11

                                    Physical Examination (IPPE)pp 7 10

                                    Physician Fee Schedule (MPSF)p 16

                                    Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                    Podiatry Servicesp 16

                                    Power Mobility Devices (PMDs)p 9

                                    Practice Managementpp 2-3 7 11-12 16 21

                                    Present On Admission (POA)p 17

                                    Preventive Servicespp 2 6-11 21

                                    Privacyp 16

                                    Prospective Payment Systemspp 12-15 17 20

                                    Quick Reference Chartspp 7 22 24

                                    Rehabilitation Therapy p 17

                                    Remittance Advice (RA)p 3

                                    Rural Healthpp 5 7 18-19

                                    Smoking Cessationp 11

                                    SNF Consolidated Billingp 21

                                    Special Initiativespp 22-24

                                    Spell Of Illnessp 7

                                    Swing Bedp 19

                                    Telehealth Servicesp 19

                                    UB-04pp 14 21

                                    Undocumented Aliensp 17

                                    Web Addresses Resourcespp 5 25

                                    Web-Based Trainingpp 20 21

                                    Womenrsquos Healthp 21

                                    Official CMS Information for Medicare Fee-For-Service Providers

                                    November 2009

                                    ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                    R

                                    • INTRODUCTION13
                                    • TABLE OF CONTENTS
                                    • GUIDES
                                    • ARTICLES
                                    • EDUCATIONAL TOOLS
                                    • BOOKLETS
                                    • BROCHURES
                                    • FACT SHEETS13
                                    • TRAINING PRESENTATIONS13
                                    • WEB-BASED TRAINING13
                                    • SPECIAL INITIATIVES13
                                    • HELPFUL RESOURCES13
                                    • PROVIDER INDEX
                                    • SUBJECT INDEX

                                      httpwwwcmshhsgovMLNProducts

                                      17Official CMS Information for Medicare Fee-For-Service Providers

                                      Present on Admission (POA) This fact sheet will help providers learn how to apply the Present on Admission (POA) indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I II and III

                                      of the official coding guidelines Subsequent to the assignment of the ICD-9-CM codes the POA indicator should then be assigned to those conditions that have been coded 3 pages (October 2008) (ICN901046 )Formats Available Downloadable only Suggested For Hospitals NPP Physicians

                                      Rehabilitation Therapy Information Resource for Medicare This fact sheet serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services coverage requirements payment systems and points

                                      of contact for further information 3 pages (March 2009) (ICN006773) Formats Available Downloadable only Suggested For NPP Outpatient Rehabilitation Therapy (Physical Occupational and Speech Language Pathology) Physicians

                                      Section 1011 Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens This fact sheet describes available funding eligibility and enrollment services to undocumented aliens

                                      as detailed in Section 1011 of the Medicare Modernization Act of 2003 (MMA) 2 pages (September 2009) (ICN900863) Formats Available Downloadable only Suggested For Ambulances Hospitals IHS NPP Physicians

                                      Skilled Nursing Facility Prospective Payment System (SNF PPS)This fact sheet provides the elements of the Skilled Nursing Facility Prospective Payment System 4 pages (August 2009) (ICN006821) Suggested For NPP Physicians SNF

                                      FACT SHEETS

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      18

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      httpwwwcmshhsgovMLNProducts

                                      Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                      Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                                      and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                                      Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                                      Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                                      Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                                      Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                                      payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                                      Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                                      Downloadable only Suggested For Hospitals

                                      Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                                      Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                                      FACT

                                      SHE

                                      ETS

                                      httpwwwcmshhsgovMLNProducts

                                      19Official CMS Information for Medicare Fee-For-Service Providers

                                      Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                                      Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                      Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                      Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                      Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                                      or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                                      Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                                      4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                      Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                                      sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                      FACT SHEETS

                                      20

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      httpwwwcmshhsgovMLNProducts

                                      Training Presentations

                                      Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                                      Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                                      CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                                      Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                                      Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                                      WEB

                                      -BAS

                                      ED T

                                      RAIN

                                      ING

                                      TRAI

                                      NING

                                      PRE

                                      SENT

                                      ATIO

                                      NS

                                      Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                                      httpwwwcmshhsgovMLNProducts

                                      21Official CMS Information for Medicare Fee-For-Service Providers

                                      Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                      Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                      Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                      Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                      Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                      Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                      Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                      World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                      WEB-BASED TRAINING

                                      22

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      httpwwwcmshhsgovMLNProducts

                                      Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                      2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                      2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                      2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                      ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                      ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                      ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                      Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                      ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                      SPEC

                                      IAL

                                      INIT

                                      IATI

                                      VES

                                      httpwwwcmshhsgovMLNProducts

                                      23Official CMS Information for Medicare Fee-For-Service Providers

                                      General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                      Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                      Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                      2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                      2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                      PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                      2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                      2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                      2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                      SPECIAL INITIATIVES

                                      24

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      httpwwwcmshhsgovMLNProducts

                                      Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                      2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                      2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                      2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                      PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                      2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                      SPEC

                                      IAL

                                      INIT

                                      IATI

                                      VES

                                      ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                      httpwwwcmshhsgovMLNProducts

                                      25Official CMS Information for Medicare Fee-For-Service Providers

                                      Helpful Resources

                                      Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                      Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                      Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                      Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                      ICD-10httpwwwcmshhsgovICD10

                                      Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                      Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                      Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                      Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                      Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                      Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                      Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                      HELPFUL RESOURCES

                                      26

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      httpwwwcmshhsgovMLNProducts26

                                      All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                      All Institutional Providerspp 9 14 20 21

                                      All Part B Providerspp 11 13

                                      All Rural Providerspp 5 7 18 19

                                      Ambulance Supplierpp 10-12 17 20

                                      Ambulatory Surgical Center (ASC)pp 9 12

                                      Chiropractorp 12

                                      Clinics Group Practicespp 5 7-9 13

                                      Community Mental Health Centerp 14See All Institutional Providers

                                      Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                      Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                      Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                      Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                      End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                      Facilitatorpp 3 5 6

                                      Federally Qualified Health Center (FQHC)pp 18-19

                                      PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                      Hospicep 14

                                      Hospitalpp 3 7-9 12-15 16-20

                                      Indian Health Service Facility (IHS)pp 6 14 17

                                      Inpatient Rehabilitation Facilitypp 9 15

                                      Laboratory Independent Clinical (ICL)pp 7-9

                                      Long Term Care Hospital (LTCH)p 15

                                      Mammography Centerpp 7-8

                                      Medical Billers Coderspp 17 22 23

                                      Medicare Dependent Hospitalp 18

                                      NPP Non-Physician Practitionerpp 2 5-25

                                      Nurse Anesthetist (CRNA)pp 2 5-25

                                      Nurse Midwife (CNM)pp 2 5-25

                                      Nurse Practitioner (NP)pp 2 5-25

                                      Nurse Specialist (CNS)pp 2 5-25

                                      Pharmacy PharmacistSee Supplier

                                      Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                      PROV

                                      IDER

                                      INDE

                                      X

                                      httpwwwcmshhsgovMLNProducts

                                      27Official CMS Information for Medicare Fee-For-Service Providers 27

                                      Physicianpp 2 5-25

                                      Physician Assistant (PA)pp 2 5-25

                                      Psychologist Clinical See All Part B Providers

                                      Psychiatric HospitalSee Hospital

                                      Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                      Rural Health Clinic (RHC)p19See also All Rural Providers

                                      Rural Referral Center (RHC)p 19See also All Rural Providers

                                      Skilled Nursing Facility (SNF)pp 17 19 21

                                      Social Worker Clinicalp 7

                                      Sole Community Hospital p 19See All Rural Providers and Hospital

                                      Supplierpp 10-11 20

                                      Teacherpp 3 5 6

                                      X-Ray Facility Portablepp 7-8

                                      NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                      PROVIDER INDEX

                                      ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                      2828

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      httpwwwcmshhsgovMLNProducts

                                      SUBJ

                                      ECT

                                      INDE

                                      X

                                      Appealsp 10

                                      Articlesp 4

                                      AV Fistulap 20

                                      Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                      Bone Mass Measurementp 9

                                      Bookletsp 8

                                      Bookmarkspp 6 7 22

                                      Brochurespp 9-11

                                      Cancer p 9

                                      Certificate Of Medical Necessity (CMN)p 20

                                      Chiropracticp 12

                                      Claims Reviewp 8

                                      Clinical Laboratory Improvement Amendments (CLIA)p 9

                                      CMS Form 1500pp 13 20

                                      Diabetesp10

                                      Electronic Prescribing (E-Prescribing)pp 22 25

                                      Email Subscription Service p12

                                      Emergency Health Servicesp 17

                                      SUBJECT INDEXEnrollment Reportingp 13

                                      Evaluation And Management Services (EampM) p 2

                                      Fact Sheetspp 12-19 22-24

                                      Fee Schedulespp 12 16

                                      Fraud And Abusepp 16 21

                                      Glaucomap 10

                                      Guidespp 2 3 25

                                      Hospital Acquired Conditions (HAC)p 14

                                      Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                      Hospital Outpatient Prospective Payment System (OPPS)p 14

                                      ICD-9-CM Diagnosis Coding pp 20 23

                                      ICD-10-CM Procedure Codingp 23

                                      Immunizationpp 7 9

                                      Kidney Dialysis Transplant ESRDpp 2 16 20

                                      Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                      Manualsp 9

                                      Medicaidp 11

                                      httpwwwcmshhsgovMLNProducts

                                      29Official CMS Information for Medicare Fee-For-Service Providers

                                      SUBJECT INDEX

                                      29

                                      Medical Reviewp 11

                                      Medicarepp 21 25

                                      Medicare Learning Network (MLN)pp 4-6 18

                                      Medicare Remit Easy Print (MREP)p 10

                                      Medicare Secondary Payer (MSP)p 16

                                      Outpatient Code Editor (OCE)p 21

                                      Overpaymentsp 11

                                      Physical Examination (IPPE)pp 7 10

                                      Physician Fee Schedule (MPSF)p 16

                                      Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                      Podiatry Servicesp 16

                                      Power Mobility Devices (PMDs)p 9

                                      Practice Managementpp 2-3 7 11-12 16 21

                                      Present On Admission (POA)p 17

                                      Preventive Servicespp 2 6-11 21

                                      Privacyp 16

                                      Prospective Payment Systemspp 12-15 17 20

                                      Quick Reference Chartspp 7 22 24

                                      Rehabilitation Therapy p 17

                                      Remittance Advice (RA)p 3

                                      Rural Healthpp 5 7 18-19

                                      Smoking Cessationp 11

                                      SNF Consolidated Billingp 21

                                      Special Initiativespp 22-24

                                      Spell Of Illnessp 7

                                      Swing Bedp 19

                                      Telehealth Servicesp 19

                                      UB-04pp 14 21

                                      Undocumented Aliensp 17

                                      Web Addresses Resourcespp 5 25

                                      Web-Based Trainingpp 20 21

                                      Womenrsquos Healthp 21

                                      Official CMS Information for Medicare Fee-For-Service Providers

                                      November 2009

                                      ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                      R

                                      • INTRODUCTION13
                                      • TABLE OF CONTENTS
                                      • GUIDES
                                      • ARTICLES
                                      • EDUCATIONAL TOOLS
                                      • BOOKLETS
                                      • BROCHURES
                                      • FACT SHEETS13
                                      • TRAINING PRESENTATIONS13
                                      • WEB-BASED TRAINING13
                                      • SPECIAL INITIATIVES13
                                      • HELPFUL RESOURCES13
                                      • PROVIDER INDEX
                                      • SUBJECT INDEX

                                        18

                                        Official CMS Information for Medicare Fee-For-Service Providers

                                        httpwwwcmshhsgovMLNProducts

                                        Fact SheetsAll Fact Sheets are available as Hard Copy Downloadable unless otherwise noted

                                        Understanding the Medicare Learning Network (MLN) This fact sheet explains the Medicare Learning Network (MLN) web pages within the CMS website It provides an overview of the MLN and where to access information

                                        and education resources that are available through the MLN 2 pages (March 2009) (ICN006844) Suggested For All Medicare Fee-For-Service Providers

                                        Rural Health Fact SheetsThe following fact sheets will be of interest to rural providers and all of these fact sheets can be ordered on a single CD as noted at the end of this section

                                        Critical Access Hospital (CAH) Program This fact sheet provides information about eligible Critical Access Hospital (CAH) providers CAH designation CAH payments reasonable cost payment principles that do not apply to CAHs election of

                                        Standard Payment Method or Optional (Elective) Payment Method Medicare Rural Pass-Through funding for certain anesthesia services Health Professional Shortage Area Incentive payments Physician Scarcity Area Bonus payments Medicare Prescription Drug Improvement and Modernization Act of 2003 provisions that impact Critical Access Hospitals and grants to states under the Medicare Rural Hospital Flexibility Program 4 pages (April 2009) (ICN006400)Formats Available Downloadable onlySuggested For CAH Hospitals Rural Health Providers

                                        Federally Qualified Health Center (FQHC) This fact sheet provides information about Federally Qualified Health Center (FQHC) designation covered FQHC services FQHC preventive primary services that are not covered FQHC

                                        payments and the Medicare Prescription Drug Improvement and Modernization Act of 2003 4 pages (April 2009) (ICN006397) Formats Available Downloadable onlySuggested For Rural Health Providers

                                        Medicare Dependent Hospital This fact sheet provides the criteria that rural hospitals must meet in order to be classified as a Medicare Dependent Hospital 2 pages (April 2009) (ICN 901683) Formats Available

                                        Downloadable only Suggested For Hospitals

                                        Medicare Disproportionate Share Hospital (DSH) This fact sheet provides information about methods to qualify for the Medicare Disproportionate Share Hospital (DSH) adjustment the Medicare Prescription Drug

                                        Improvement and Modernization Act of 2003 and the Deficit Reduction Act of 2005 provisions that impact DSHs the number of beds in hospital determination and Medicare DSH payment adjustment formulas 4 pages (July 2009) (ICN006741) Suggested For Hospitals Rural Health Providers

                                        FACT

                                        SHE

                                        ETS

                                        httpwwwcmshhsgovMLNProducts

                                        19Official CMS Information for Medicare Fee-For-Service Providers

                                        Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                                        Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                        Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                        Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                        Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                                        or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                                        Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                                        4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                        Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                                        sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                        FACT SHEETS

                                        20

                                        Official CMS Information for Medicare Fee-For-Service Providers

                                        httpwwwcmshhsgovMLNProducts

                                        Training Presentations

                                        Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                                        Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                                        CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                                        Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                                        Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                                        WEB

                                        -BAS

                                        ED T

                                        RAIN

                                        ING

                                        TRAI

                                        NING

                                        PRE

                                        SENT

                                        ATIO

                                        NS

                                        Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                                        httpwwwcmshhsgovMLNProducts

                                        21Official CMS Information for Medicare Fee-For-Service Providers

                                        Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                        Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                        Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                        Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                        Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                        Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                        Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                        World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                        WEB-BASED TRAINING

                                        22

                                        Official CMS Information for Medicare Fee-For-Service Providers

                                        httpwwwcmshhsgovMLNProducts

                                        Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                        2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                        2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                        2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                        ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                        ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                        ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                        Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                        ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                        SPEC

                                        IAL

                                        INIT

                                        IATI

                                        VES

                                        httpwwwcmshhsgovMLNProducts

                                        23Official CMS Information for Medicare Fee-For-Service Providers

                                        General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                        Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                        Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                        2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                        2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                        PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                        2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                        2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                        2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                        SPECIAL INITIATIVES

                                        24

                                        Official CMS Information for Medicare Fee-For-Service Providers

                                        httpwwwcmshhsgovMLNProducts

                                        Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                        2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                        2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                        2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                        PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                        2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                        SPEC

                                        IAL

                                        INIT

                                        IATI

                                        VES

                                        ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                        httpwwwcmshhsgovMLNProducts

                                        25Official CMS Information for Medicare Fee-For-Service Providers

                                        Helpful Resources

                                        Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                        Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                        Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                        Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                        ICD-10httpwwwcmshhsgovICD10

                                        Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                        Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                        Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                        Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                        Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                        Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                        Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                        HELPFUL RESOURCES

                                        26

                                        Official CMS Information for Medicare Fee-For-Service Providers

                                        httpwwwcmshhsgovMLNProducts26

                                        All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                        All Institutional Providerspp 9 14 20 21

                                        All Part B Providerspp 11 13

                                        All Rural Providerspp 5 7 18 19

                                        Ambulance Supplierpp 10-12 17 20

                                        Ambulatory Surgical Center (ASC)pp 9 12

                                        Chiropractorp 12

                                        Clinics Group Practicespp 5 7-9 13

                                        Community Mental Health Centerp 14See All Institutional Providers

                                        Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                        Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                        Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                        Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                        End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                        Facilitatorpp 3 5 6

                                        Federally Qualified Health Center (FQHC)pp 18-19

                                        PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                        Hospicep 14

                                        Hospitalpp 3 7-9 12-15 16-20

                                        Indian Health Service Facility (IHS)pp 6 14 17

                                        Inpatient Rehabilitation Facilitypp 9 15

                                        Laboratory Independent Clinical (ICL)pp 7-9

                                        Long Term Care Hospital (LTCH)p 15

                                        Mammography Centerpp 7-8

                                        Medical Billers Coderspp 17 22 23

                                        Medicare Dependent Hospitalp 18

                                        NPP Non-Physician Practitionerpp 2 5-25

                                        Nurse Anesthetist (CRNA)pp 2 5-25

                                        Nurse Midwife (CNM)pp 2 5-25

                                        Nurse Practitioner (NP)pp 2 5-25

                                        Nurse Specialist (CNS)pp 2 5-25

                                        Pharmacy PharmacistSee Supplier

                                        Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                        PROV

                                        IDER

                                        INDE

                                        X

                                        httpwwwcmshhsgovMLNProducts

                                        27Official CMS Information for Medicare Fee-For-Service Providers 27

                                        Physicianpp 2 5-25

                                        Physician Assistant (PA)pp 2 5-25

                                        Psychologist Clinical See All Part B Providers

                                        Psychiatric HospitalSee Hospital

                                        Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                        Rural Health Clinic (RHC)p19See also All Rural Providers

                                        Rural Referral Center (RHC)p 19See also All Rural Providers

                                        Skilled Nursing Facility (SNF)pp 17 19 21

                                        Social Worker Clinicalp 7

                                        Sole Community Hospital p 19See All Rural Providers and Hospital

                                        Supplierpp 10-11 20

                                        Teacherpp 3 5 6

                                        X-Ray Facility Portablepp 7-8

                                        NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                        PROVIDER INDEX

                                        ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                        2828

                                        Official CMS Information for Medicare Fee-For-Service Providers

                                        httpwwwcmshhsgovMLNProducts

                                        SUBJ

                                        ECT

                                        INDE

                                        X

                                        Appealsp 10

                                        Articlesp 4

                                        AV Fistulap 20

                                        Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                        Bone Mass Measurementp 9

                                        Bookletsp 8

                                        Bookmarkspp 6 7 22

                                        Brochurespp 9-11

                                        Cancer p 9

                                        Certificate Of Medical Necessity (CMN)p 20

                                        Chiropracticp 12

                                        Claims Reviewp 8

                                        Clinical Laboratory Improvement Amendments (CLIA)p 9

                                        CMS Form 1500pp 13 20

                                        Diabetesp10

                                        Electronic Prescribing (E-Prescribing)pp 22 25

                                        Email Subscription Service p12

                                        Emergency Health Servicesp 17

                                        SUBJECT INDEXEnrollment Reportingp 13

                                        Evaluation And Management Services (EampM) p 2

                                        Fact Sheetspp 12-19 22-24

                                        Fee Schedulespp 12 16

                                        Fraud And Abusepp 16 21

                                        Glaucomap 10

                                        Guidespp 2 3 25

                                        Hospital Acquired Conditions (HAC)p 14

                                        Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                        Hospital Outpatient Prospective Payment System (OPPS)p 14

                                        ICD-9-CM Diagnosis Coding pp 20 23

                                        ICD-10-CM Procedure Codingp 23

                                        Immunizationpp 7 9

                                        Kidney Dialysis Transplant ESRDpp 2 16 20

                                        Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                        Manualsp 9

                                        Medicaidp 11

                                        httpwwwcmshhsgovMLNProducts

                                        29Official CMS Information for Medicare Fee-For-Service Providers

                                        SUBJECT INDEX

                                        29

                                        Medical Reviewp 11

                                        Medicarepp 21 25

                                        Medicare Learning Network (MLN)pp 4-6 18

                                        Medicare Remit Easy Print (MREP)p 10

                                        Medicare Secondary Payer (MSP)p 16

                                        Outpatient Code Editor (OCE)p 21

                                        Overpaymentsp 11

                                        Physical Examination (IPPE)pp 7 10

                                        Physician Fee Schedule (MPSF)p 16

                                        Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                        Podiatry Servicesp 16

                                        Power Mobility Devices (PMDs)p 9

                                        Practice Managementpp 2-3 7 11-12 16 21

                                        Present On Admission (POA)p 17

                                        Preventive Servicespp 2 6-11 21

                                        Privacyp 16

                                        Prospective Payment Systemspp 12-15 17 20

                                        Quick Reference Chartspp 7 22 24

                                        Rehabilitation Therapy p 17

                                        Remittance Advice (RA)p 3

                                        Rural Healthpp 5 7 18-19

                                        Smoking Cessationp 11

                                        SNF Consolidated Billingp 21

                                        Special Initiativespp 22-24

                                        Spell Of Illnessp 7

                                        Swing Bedp 19

                                        Telehealth Servicesp 19

                                        UB-04pp 14 21

                                        Undocumented Aliensp 17

                                        Web Addresses Resourcespp 5 25

                                        Web-Based Trainingpp 20 21

                                        Womenrsquos Healthp 21

                                        Official CMS Information for Medicare Fee-For-Service Providers

                                        November 2009

                                        ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                        R

                                        • INTRODUCTION13
                                        • TABLE OF CONTENTS
                                        • GUIDES
                                        • ARTICLES
                                        • EDUCATIONAL TOOLS
                                        • BOOKLETS
                                        • BROCHURES
                                        • FACT SHEETS13
                                        • TRAINING PRESENTATIONS13
                                        • WEB-BASED TRAINING13
                                        • SPECIAL INITIATIVES13
                                        • HELPFUL RESOURCES13
                                        • PROVIDER INDEX
                                        • SUBJECT INDEX

                                          httpwwwcmshhsgovMLNProducts

                                          19Official CMS Information for Medicare Fee-For-Service Providers

                                          Rural Health Clinic (RHC) This fact sheet provides information about Rural Health Clinic (RHC) services Medicare certification as an RHC RHC visits RHC payments cost reports and annual reconciliation 4 pages (April 2009) (ICN006398)

                                          Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                          Rural Referral Center (RRC) This fact sheet provides information about the Rural Referral Center (RRC) program requirements 2 pages (April 2009) (ICN006742) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                          Sole Community Hospital (SCH) This fact sheet provides information about Sole Community Hospital classification and payments 2 pages (April 2009) (ICN006399) Formats Available Downloadable only Suggested For Hospitals Rural Health Providers

                                          Swing Bed This fact sheet provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds as needed to provide either acute

                                          or Skilled Nursing Facility care 2 pages (April 2009) (ICN006951) Formats Available Downloadable only Suggested For Critical Access Hospitals Hospitals NPP Physicians Rural Health Providers Skilled Nursing Facilities

                                          Telehealth ServicesThis fact sheet provides information about originating sites distant site practitioners telehealth services and billing and payment for professional services furnished via telehealth and for the originating site facility fee

                                          4 pages (July 2009) (ICN 901705)Suggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                          Rural Health Fact Sheet SeriesThis CD Rom consists of nine rural health fact sheets which provide information about rural facility types and coverage and payment policies The fact

                                          sheets included in this series are bull Critical Access Hospitalbull Federally Qualified Health Centerbull Medicare Dependent Hospitalbull Medicare Disproportionate Share Hospitalbull Rural Health Clinicbull Rural Referral Centerbull Sole Community Hospitalbull Swing Bedbull Telehealth Services(September 2009) (ICN901704) Formats Available CD RomSuggested For All Medicare Fee-For-Service Providers Rural Health Providers

                                          FACT SHEETS

                                          20

                                          Official CMS Information for Medicare Fee-For-Service Providers

                                          httpwwwcmshhsgovMLNProducts

                                          Training Presentations

                                          Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                                          Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                                          CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                                          Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                                          Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                                          WEB

                                          -BAS

                                          ED T

                                          RAIN

                                          ING

                                          TRAI

                                          NING

                                          PRE

                                          SENT

                                          ATIO

                                          NS

                                          Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                                          httpwwwcmshhsgovMLNProducts

                                          21Official CMS Information for Medicare Fee-For-Service Providers

                                          Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                          Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                          Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                          Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                          Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                          Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                          Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                          World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                          WEB-BASED TRAINING

                                          22

                                          Official CMS Information for Medicare Fee-For-Service Providers

                                          httpwwwcmshhsgovMLNProducts

                                          Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                          2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                          2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                          2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                          ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                          ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                          ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                          Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                          ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                          SPEC

                                          IAL

                                          INIT

                                          IATI

                                          VES

                                          httpwwwcmshhsgovMLNProducts

                                          23Official CMS Information for Medicare Fee-For-Service Providers

                                          General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                          Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                          Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                          2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                          2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                          PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                          2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                          2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                          2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                          SPECIAL INITIATIVES

                                          24

                                          Official CMS Information for Medicare Fee-For-Service Providers

                                          httpwwwcmshhsgovMLNProducts

                                          Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                          2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                          2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                          2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                          PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                          2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                          SPEC

                                          IAL

                                          INIT

                                          IATI

                                          VES

                                          ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                          httpwwwcmshhsgovMLNProducts

                                          25Official CMS Information for Medicare Fee-For-Service Providers

                                          Helpful Resources

                                          Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                          Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                          Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                          Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                          ICD-10httpwwwcmshhsgovICD10

                                          Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                          Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                          Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                          Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                          Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                          Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                          Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                          HELPFUL RESOURCES

                                          26

                                          Official CMS Information for Medicare Fee-For-Service Providers

                                          httpwwwcmshhsgovMLNProducts26

                                          All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                          All Institutional Providerspp 9 14 20 21

                                          All Part B Providerspp 11 13

                                          All Rural Providerspp 5 7 18 19

                                          Ambulance Supplierpp 10-12 17 20

                                          Ambulatory Surgical Center (ASC)pp 9 12

                                          Chiropractorp 12

                                          Clinics Group Practicespp 5 7-9 13

                                          Community Mental Health Centerp 14See All Institutional Providers

                                          Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                          Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                          Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                          Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                          End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                          Facilitatorpp 3 5 6

                                          Federally Qualified Health Center (FQHC)pp 18-19

                                          PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                          Hospicep 14

                                          Hospitalpp 3 7-9 12-15 16-20

                                          Indian Health Service Facility (IHS)pp 6 14 17

                                          Inpatient Rehabilitation Facilitypp 9 15

                                          Laboratory Independent Clinical (ICL)pp 7-9

                                          Long Term Care Hospital (LTCH)p 15

                                          Mammography Centerpp 7-8

                                          Medical Billers Coderspp 17 22 23

                                          Medicare Dependent Hospitalp 18

                                          NPP Non-Physician Practitionerpp 2 5-25

                                          Nurse Anesthetist (CRNA)pp 2 5-25

                                          Nurse Midwife (CNM)pp 2 5-25

                                          Nurse Practitioner (NP)pp 2 5-25

                                          Nurse Specialist (CNS)pp 2 5-25

                                          Pharmacy PharmacistSee Supplier

                                          Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                          PROV

                                          IDER

                                          INDE

                                          X

                                          httpwwwcmshhsgovMLNProducts

                                          27Official CMS Information for Medicare Fee-For-Service Providers 27

                                          Physicianpp 2 5-25

                                          Physician Assistant (PA)pp 2 5-25

                                          Psychologist Clinical See All Part B Providers

                                          Psychiatric HospitalSee Hospital

                                          Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                          Rural Health Clinic (RHC)p19See also All Rural Providers

                                          Rural Referral Center (RHC)p 19See also All Rural Providers

                                          Skilled Nursing Facility (SNF)pp 17 19 21

                                          Social Worker Clinicalp 7

                                          Sole Community Hospital p 19See All Rural Providers and Hospital

                                          Supplierpp 10-11 20

                                          Teacherpp 3 5 6

                                          X-Ray Facility Portablepp 7-8

                                          NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                          PROVIDER INDEX

                                          ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                          2828

                                          Official CMS Information for Medicare Fee-For-Service Providers

                                          httpwwwcmshhsgovMLNProducts

                                          SUBJ

                                          ECT

                                          INDE

                                          X

                                          Appealsp 10

                                          Articlesp 4

                                          AV Fistulap 20

                                          Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                          Bone Mass Measurementp 9

                                          Bookletsp 8

                                          Bookmarkspp 6 7 22

                                          Brochurespp 9-11

                                          Cancer p 9

                                          Certificate Of Medical Necessity (CMN)p 20

                                          Chiropracticp 12

                                          Claims Reviewp 8

                                          Clinical Laboratory Improvement Amendments (CLIA)p 9

                                          CMS Form 1500pp 13 20

                                          Diabetesp10

                                          Electronic Prescribing (E-Prescribing)pp 22 25

                                          Email Subscription Service p12

                                          Emergency Health Servicesp 17

                                          SUBJECT INDEXEnrollment Reportingp 13

                                          Evaluation And Management Services (EampM) p 2

                                          Fact Sheetspp 12-19 22-24

                                          Fee Schedulespp 12 16

                                          Fraud And Abusepp 16 21

                                          Glaucomap 10

                                          Guidespp 2 3 25

                                          Hospital Acquired Conditions (HAC)p 14

                                          Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                          Hospital Outpatient Prospective Payment System (OPPS)p 14

                                          ICD-9-CM Diagnosis Coding pp 20 23

                                          ICD-10-CM Procedure Codingp 23

                                          Immunizationpp 7 9

                                          Kidney Dialysis Transplant ESRDpp 2 16 20

                                          Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                          Manualsp 9

                                          Medicaidp 11

                                          httpwwwcmshhsgovMLNProducts

                                          29Official CMS Information for Medicare Fee-For-Service Providers

                                          SUBJECT INDEX

                                          29

                                          Medical Reviewp 11

                                          Medicarepp 21 25

                                          Medicare Learning Network (MLN)pp 4-6 18

                                          Medicare Remit Easy Print (MREP)p 10

                                          Medicare Secondary Payer (MSP)p 16

                                          Outpatient Code Editor (OCE)p 21

                                          Overpaymentsp 11

                                          Physical Examination (IPPE)pp 7 10

                                          Physician Fee Schedule (MPSF)p 16

                                          Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                          Podiatry Servicesp 16

                                          Power Mobility Devices (PMDs)p 9

                                          Practice Managementpp 2-3 7 11-12 16 21

                                          Present On Admission (POA)p 17

                                          Preventive Servicespp 2 6-11 21

                                          Privacyp 16

                                          Prospective Payment Systemspp 12-15 17 20

                                          Quick Reference Chartspp 7 22 24

                                          Rehabilitation Therapy p 17

                                          Remittance Advice (RA)p 3

                                          Rural Healthpp 5 7 18-19

                                          Smoking Cessationp 11

                                          SNF Consolidated Billingp 21

                                          Special Initiativespp 22-24

                                          Spell Of Illnessp 7

                                          Swing Bedp 19

                                          Telehealth Servicesp 19

                                          UB-04pp 14 21

                                          Undocumented Aliensp 17

                                          Web Addresses Resourcespp 5 25

                                          Web-Based Trainingpp 20 21

                                          Womenrsquos Healthp 21

                                          Official CMS Information for Medicare Fee-For-Service Providers

                                          November 2009

                                          ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                          R

                                          • INTRODUCTION13
                                          • TABLE OF CONTENTS
                                          • GUIDES
                                          • ARTICLES
                                          • EDUCATIONAL TOOLS
                                          • BOOKLETS
                                          • BROCHURES
                                          • FACT SHEETS13
                                          • TRAINING PRESENTATIONS13
                                          • WEB-BASED TRAINING13
                                          • SPECIAL INITIATIVES13
                                          • HELPFUL RESOURCES13
                                          • PROVIDER INDEX
                                          • SUBJECT INDEX

                                            20

                                            Official CMS Information for Medicare Fee-For-Service Providers

                                            httpwwwcmshhsgovMLNProducts

                                            Training Presentations

                                            Web-Based Training CoursesAccess at httpwwwcmshhsgovMLNProducts

                                            Acute Hospital Inpatient Prospective Payment System (IPPS) This web-based training course provides an overview of the Acute Hospital Inpatient Prospective Payment System (IPPS) It includes a basic explanation of inpatient hospital coverage billing and payment under the IPPS 30 minutes (July 2008) Suggested For Hospitals NPP Physicians

                                            CMS Form 1500 This web-based training course provides information that will allow you to file Medicare Part B claims accurately and reduce the chances of receiving unprocessable rejections 60 minutes (July 2008) Suggested For Ambulances DMEPOS Suppliers NPP Other Suppliers Physicians

                                            Certificate of Medical Necessity (CMN)This web-based training course contains information about the Certificate of Medical Necessity commonly known as CMN This course will be helpful to physicians health care professionals and medical administrative staff in completion submission and maintenance of the documentation required to verify the CMN 60 minutes (June 2009) Suggested For DMEPOS Suppliers Institutions NPP Physicians

                                            Diagnosis Coding Using the ICD-9-CMThis web-based training course teaches you how to select accurate diagnosis codes from the ICD-9-CM volumes and how to use diagnosis codes correctly on Medicare claim forms 75 minutes (May 2007) Suggested For All Medicare Fee-For-Service Providers

                                            WEB

                                            -BAS

                                            ED T

                                            RAIN

                                            ING

                                            TRAI

                                            NING

                                            PRE

                                            SENT

                                            ATIO

                                            NS

                                            Creating AV Fistulas in all Eligible Hemodialysis Patients The Medicare Learning Network is making this training module available which was developed by the University of Oklahoma College of Medicine Office of Continuing Education in conjunction with the University of Oklahoma College of Medicine Tulsa Department of Surgery This training module consists of several presentations related to AV fistulas (November 2005) (ICN006709)The web address for this course is httpcmeouhscedu5E016webtropageshtm on the Internet Formats Available CD Rom DVDSuggested For End Stage Renal Disease Facilities NPP Physicians

                                            httpwwwcmshhsgovMLNProducts

                                            21Official CMS Information for Medicare Fee-For-Service Providers

                                            Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                            Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                            Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                            Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                            Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                            Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                            Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                            World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                            WEB-BASED TRAINING

                                            22

                                            Official CMS Information for Medicare Fee-For-Service Providers

                                            httpwwwcmshhsgovMLNProducts

                                            Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                            2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                            2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                            2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                            ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                            ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                            ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                            Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                            ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                            SPEC

                                            IAL

                                            INIT

                                            IATI

                                            VES

                                            httpwwwcmshhsgovMLNProducts

                                            23Official CMS Information for Medicare Fee-For-Service Providers

                                            General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                            Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                            Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                            2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                            2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                            PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                            2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                            2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                            2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                            SPECIAL INITIATIVES

                                            24

                                            Official CMS Information for Medicare Fee-For-Service Providers

                                            httpwwwcmshhsgovMLNProducts

                                            Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                            2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                            2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                            2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                            PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                            2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                            SPEC

                                            IAL

                                            INIT

                                            IATI

                                            VES

                                            ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                            httpwwwcmshhsgovMLNProducts

                                            25Official CMS Information for Medicare Fee-For-Service Providers

                                            Helpful Resources

                                            Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                            Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                            Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                            Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                            ICD-10httpwwwcmshhsgovICD10

                                            Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                            Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                            Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                            Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                            Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                            Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                            Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                            HELPFUL RESOURCES

                                            26

                                            Official CMS Information for Medicare Fee-For-Service Providers

                                            httpwwwcmshhsgovMLNProducts26

                                            All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                            All Institutional Providerspp 9 14 20 21

                                            All Part B Providerspp 11 13

                                            All Rural Providerspp 5 7 18 19

                                            Ambulance Supplierpp 10-12 17 20

                                            Ambulatory Surgical Center (ASC)pp 9 12

                                            Chiropractorp 12

                                            Clinics Group Practicespp 5 7-9 13

                                            Community Mental Health Centerp 14See All Institutional Providers

                                            Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                            Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                            Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                            Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                            End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                            Facilitatorpp 3 5 6

                                            Federally Qualified Health Center (FQHC)pp 18-19

                                            PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                            Hospicep 14

                                            Hospitalpp 3 7-9 12-15 16-20

                                            Indian Health Service Facility (IHS)pp 6 14 17

                                            Inpatient Rehabilitation Facilitypp 9 15

                                            Laboratory Independent Clinical (ICL)pp 7-9

                                            Long Term Care Hospital (LTCH)p 15

                                            Mammography Centerpp 7-8

                                            Medical Billers Coderspp 17 22 23

                                            Medicare Dependent Hospitalp 18

                                            NPP Non-Physician Practitionerpp 2 5-25

                                            Nurse Anesthetist (CRNA)pp 2 5-25

                                            Nurse Midwife (CNM)pp 2 5-25

                                            Nurse Practitioner (NP)pp 2 5-25

                                            Nurse Specialist (CNS)pp 2 5-25

                                            Pharmacy PharmacistSee Supplier

                                            Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                            PROV

                                            IDER

                                            INDE

                                            X

                                            httpwwwcmshhsgovMLNProducts

                                            27Official CMS Information for Medicare Fee-For-Service Providers 27

                                            Physicianpp 2 5-25

                                            Physician Assistant (PA)pp 2 5-25

                                            Psychologist Clinical See All Part B Providers

                                            Psychiatric HospitalSee Hospital

                                            Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                            Rural Health Clinic (RHC)p19See also All Rural Providers

                                            Rural Referral Center (RHC)p 19See also All Rural Providers

                                            Skilled Nursing Facility (SNF)pp 17 19 21

                                            Social Worker Clinicalp 7

                                            Sole Community Hospital p 19See All Rural Providers and Hospital

                                            Supplierpp 10-11 20

                                            Teacherpp 3 5 6

                                            X-Ray Facility Portablepp 7-8

                                            NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                            PROVIDER INDEX

                                            ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                            2828

                                            Official CMS Information for Medicare Fee-For-Service Providers

                                            httpwwwcmshhsgovMLNProducts

                                            SUBJ

                                            ECT

                                            INDE

                                            X

                                            Appealsp 10

                                            Articlesp 4

                                            AV Fistulap 20

                                            Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                            Bone Mass Measurementp 9

                                            Bookletsp 8

                                            Bookmarkspp 6 7 22

                                            Brochurespp 9-11

                                            Cancer p 9

                                            Certificate Of Medical Necessity (CMN)p 20

                                            Chiropracticp 12

                                            Claims Reviewp 8

                                            Clinical Laboratory Improvement Amendments (CLIA)p 9

                                            CMS Form 1500pp 13 20

                                            Diabetesp10

                                            Electronic Prescribing (E-Prescribing)pp 22 25

                                            Email Subscription Service p12

                                            Emergency Health Servicesp 17

                                            SUBJECT INDEXEnrollment Reportingp 13

                                            Evaluation And Management Services (EampM) p 2

                                            Fact Sheetspp 12-19 22-24

                                            Fee Schedulespp 12 16

                                            Fraud And Abusepp 16 21

                                            Glaucomap 10

                                            Guidespp 2 3 25

                                            Hospital Acquired Conditions (HAC)p 14

                                            Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                            Hospital Outpatient Prospective Payment System (OPPS)p 14

                                            ICD-9-CM Diagnosis Coding pp 20 23

                                            ICD-10-CM Procedure Codingp 23

                                            Immunizationpp 7 9

                                            Kidney Dialysis Transplant ESRDpp 2 16 20

                                            Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                            Manualsp 9

                                            Medicaidp 11

                                            httpwwwcmshhsgovMLNProducts

                                            29Official CMS Information for Medicare Fee-For-Service Providers

                                            SUBJECT INDEX

                                            29

                                            Medical Reviewp 11

                                            Medicarepp 21 25

                                            Medicare Learning Network (MLN)pp 4-6 18

                                            Medicare Remit Easy Print (MREP)p 10

                                            Medicare Secondary Payer (MSP)p 16

                                            Outpatient Code Editor (OCE)p 21

                                            Overpaymentsp 11

                                            Physical Examination (IPPE)pp 7 10

                                            Physician Fee Schedule (MPSF)p 16

                                            Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                            Podiatry Servicesp 16

                                            Power Mobility Devices (PMDs)p 9

                                            Practice Managementpp 2-3 7 11-12 16 21

                                            Present On Admission (POA)p 17

                                            Preventive Servicespp 2 6-11 21

                                            Privacyp 16

                                            Prospective Payment Systemspp 12-15 17 20

                                            Quick Reference Chartspp 7 22 24

                                            Rehabilitation Therapy p 17

                                            Remittance Advice (RA)p 3

                                            Rural Healthpp 5 7 18-19

                                            Smoking Cessationp 11

                                            SNF Consolidated Billingp 21

                                            Special Initiativespp 22-24

                                            Spell Of Illnessp 7

                                            Swing Bedp 19

                                            Telehealth Servicesp 19

                                            UB-04pp 14 21

                                            Undocumented Aliensp 17

                                            Web Addresses Resourcespp 5 25

                                            Web-Based Trainingpp 20 21

                                            Womenrsquos Healthp 21

                                            Official CMS Information for Medicare Fee-For-Service Providers

                                            November 2009

                                            ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                            R

                                            • INTRODUCTION13
                                            • TABLE OF CONTENTS
                                            • GUIDES
                                            • ARTICLES
                                            • EDUCATIONAL TOOLS
                                            • BOOKLETS
                                            • BROCHURES
                                            • FACT SHEETS13
                                            • TRAINING PRESENTATIONS13
                                            • WEB-BASED TRAINING13
                                            • SPECIAL INITIATIVES13
                                            • HELPFUL RESOURCES13
                                            • PROVIDER INDEX
                                            • SUBJECT INDEX

                                              httpwwwcmshhsgovMLNProducts

                                              21Official CMS Information for Medicare Fee-For-Service Providers

                                              Front Office Medicare This web-based training course provides essential knowledge needed for ldquochecking inrdquo Medicare patients 60 minutes (January 2008) Suggested For All Medicare Fee-For-Service Providers

                                              Medicare Fraud and Abuse This web-based training course will teach you to identify Medicare fraud and abuse You will also learn what safeguards to use to protect against fraud and abuse and what liability and penalties you could face if you commit fraud or abuse 85 minutes (January 2009) Suggested For All Medicare Providers

                                              Medicare Preventive Services Part 3 This web-based training course provides information about Medicarersquos coverage for mammography services pap tests pelvic exams colorectal cancer screenings prostate cancer screenings bone mass measurements and glaucoma screenings 90 minutes (October 2007)Suggested For All Medicare Fee-For-Service Providers

                                              Outpatient Code Editor (OCE) This web-based training is useful for physicians and other health care professionals This course addresses the OCE in the Fiscal Intermediary Standard System 60 minutes (April 2009) Suggested For NPP Physicians

                                              Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (E-Prescribing) This web-based training provides information to physicians health care professionals and medical administrative staff in the completion submission and maintenance of the documentation required to successfully participate in Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive (E-Prescribing) programsSuggested For NPP Physicians

                                              Skilled Nursing Facility Consolidated Billing (SNF CB)This web-based training course contains information about Skilled Nursing Facility Consolidated Billing ldquounder arrangementrdquo agreements between Skilled Nursing Facilities and other providers or suppliers 45 minutes (October 2008) Suggested For DMEPOS Suppliers NPP Other Suppliers Physicians SNF

                                              Uniform Billing (UB-04) This web-based training course addresses hard copy and electronic billing requirements for Medicare institutional providers (ie hospitals skilled nursing facilities End Stage Renal Disease providers home health agencies hospices and outpatient rehabilitation clinics) 114 minutes (July 2008) Suggested For All Medicare Institutional Providers

                                              World Of Medicare This web-based training course will introduce you to the Medicare Program You will learn about its purpose and history of Medicare the types of Medicare coverage the roles agencies and contractors play and the claims handling process You will also learn about beneficiary-related topics such as eligibility and benefit options 60 minutes (September 2007)Suggested For All Medicare Providers Other MLN Users

                                              WEB-BASED TRAINING

                                              22

                                              Official CMS Information for Medicare Fee-For-Service Providers

                                              httpwwwcmshhsgovMLNProducts

                                              Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                              2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                              2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                              2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                              ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                              ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                              ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                              Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                              ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                              SPEC

                                              IAL

                                              INIT

                                              IATI

                                              VES

                                              httpwwwcmshhsgovMLNProducts

                                              23Official CMS Information for Medicare Fee-For-Service Providers

                                              General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                              Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                              Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                              2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                              2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                              PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                              2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                              2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                              2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                              SPECIAL INITIATIVES

                                              24

                                              Official CMS Information for Medicare Fee-For-Service Providers

                                              httpwwwcmshhsgovMLNProducts

                                              Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                              2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                              2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                              2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                              PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                              2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                              SPEC

                                              IAL

                                              INIT

                                              IATI

                                              VES

                                              ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                              httpwwwcmshhsgovMLNProducts

                                              25Official CMS Information for Medicare Fee-For-Service Providers

                                              Helpful Resources

                                              Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                              Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                              Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                              Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                              ICD-10httpwwwcmshhsgovICD10

                                              Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                              Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                              Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                              Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                              Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                              Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                              Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                              HELPFUL RESOURCES

                                              26

                                              Official CMS Information for Medicare Fee-For-Service Providers

                                              httpwwwcmshhsgovMLNProducts26

                                              All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                              All Institutional Providerspp 9 14 20 21

                                              All Part B Providerspp 11 13

                                              All Rural Providerspp 5 7 18 19

                                              Ambulance Supplierpp 10-12 17 20

                                              Ambulatory Surgical Center (ASC)pp 9 12

                                              Chiropractorp 12

                                              Clinics Group Practicespp 5 7-9 13

                                              Community Mental Health Centerp 14See All Institutional Providers

                                              Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                              Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                              Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                              Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                              End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                              Facilitatorpp 3 5 6

                                              Federally Qualified Health Center (FQHC)pp 18-19

                                              PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                              Hospicep 14

                                              Hospitalpp 3 7-9 12-15 16-20

                                              Indian Health Service Facility (IHS)pp 6 14 17

                                              Inpatient Rehabilitation Facilitypp 9 15

                                              Laboratory Independent Clinical (ICL)pp 7-9

                                              Long Term Care Hospital (LTCH)p 15

                                              Mammography Centerpp 7-8

                                              Medical Billers Coderspp 17 22 23

                                              Medicare Dependent Hospitalp 18

                                              NPP Non-Physician Practitionerpp 2 5-25

                                              Nurse Anesthetist (CRNA)pp 2 5-25

                                              Nurse Midwife (CNM)pp 2 5-25

                                              Nurse Practitioner (NP)pp 2 5-25

                                              Nurse Specialist (CNS)pp 2 5-25

                                              Pharmacy PharmacistSee Supplier

                                              Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                              PROV

                                              IDER

                                              INDE

                                              X

                                              httpwwwcmshhsgovMLNProducts

                                              27Official CMS Information for Medicare Fee-For-Service Providers 27

                                              Physicianpp 2 5-25

                                              Physician Assistant (PA)pp 2 5-25

                                              Psychologist Clinical See All Part B Providers

                                              Psychiatric HospitalSee Hospital

                                              Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                              Rural Health Clinic (RHC)p19See also All Rural Providers

                                              Rural Referral Center (RHC)p 19See also All Rural Providers

                                              Skilled Nursing Facility (SNF)pp 17 19 21

                                              Social Worker Clinicalp 7

                                              Sole Community Hospital p 19See All Rural Providers and Hospital

                                              Supplierpp 10-11 20

                                              Teacherpp 3 5 6

                                              X-Ray Facility Portablepp 7-8

                                              NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                              PROVIDER INDEX

                                              ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                              2828

                                              Official CMS Information for Medicare Fee-For-Service Providers

                                              httpwwwcmshhsgovMLNProducts

                                              SUBJ

                                              ECT

                                              INDE

                                              X

                                              Appealsp 10

                                              Articlesp 4

                                              AV Fistulap 20

                                              Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                              Bone Mass Measurementp 9

                                              Bookletsp 8

                                              Bookmarkspp 6 7 22

                                              Brochurespp 9-11

                                              Cancer p 9

                                              Certificate Of Medical Necessity (CMN)p 20

                                              Chiropracticp 12

                                              Claims Reviewp 8

                                              Clinical Laboratory Improvement Amendments (CLIA)p 9

                                              CMS Form 1500pp 13 20

                                              Diabetesp10

                                              Electronic Prescribing (E-Prescribing)pp 22 25

                                              Email Subscription Service p12

                                              Emergency Health Servicesp 17

                                              SUBJECT INDEXEnrollment Reportingp 13

                                              Evaluation And Management Services (EampM) p 2

                                              Fact Sheetspp 12-19 22-24

                                              Fee Schedulespp 12 16

                                              Fraud And Abusepp 16 21

                                              Glaucomap 10

                                              Guidespp 2 3 25

                                              Hospital Acquired Conditions (HAC)p 14

                                              Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                              Hospital Outpatient Prospective Payment System (OPPS)p 14

                                              ICD-9-CM Diagnosis Coding pp 20 23

                                              ICD-10-CM Procedure Codingp 23

                                              Immunizationpp 7 9

                                              Kidney Dialysis Transplant ESRDpp 2 16 20

                                              Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                              Manualsp 9

                                              Medicaidp 11

                                              httpwwwcmshhsgovMLNProducts

                                              29Official CMS Information for Medicare Fee-For-Service Providers

                                              SUBJECT INDEX

                                              29

                                              Medical Reviewp 11

                                              Medicarepp 21 25

                                              Medicare Learning Network (MLN)pp 4-6 18

                                              Medicare Remit Easy Print (MREP)p 10

                                              Medicare Secondary Payer (MSP)p 16

                                              Outpatient Code Editor (OCE)p 21

                                              Overpaymentsp 11

                                              Physical Examination (IPPE)pp 7 10

                                              Physician Fee Schedule (MPSF)p 16

                                              Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                              Podiatry Servicesp 16

                                              Power Mobility Devices (PMDs)p 9

                                              Practice Managementpp 2-3 7 11-12 16 21

                                              Present On Admission (POA)p 17

                                              Preventive Servicespp 2 6-11 21

                                              Privacyp 16

                                              Prospective Payment Systemspp 12-15 17 20

                                              Quick Reference Chartspp 7 22 24

                                              Rehabilitation Therapy p 17

                                              Remittance Advice (RA)p 3

                                              Rural Healthpp 5 7 18-19

                                              Smoking Cessationp 11

                                              SNF Consolidated Billingp 21

                                              Special Initiativespp 22-24

                                              Spell Of Illnessp 7

                                              Swing Bedp 19

                                              Telehealth Servicesp 19

                                              UB-04pp 14 21

                                              Undocumented Aliensp 17

                                              Web Addresses Resourcespp 5 25

                                              Web-Based Trainingpp 20 21

                                              Womenrsquos Healthp 21

                                              Official CMS Information for Medicare Fee-For-Service Providers

                                              November 2009

                                              ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                              R

                                              • INTRODUCTION13
                                              • TABLE OF CONTENTS
                                              • GUIDES
                                              • ARTICLES
                                              • EDUCATIONAL TOOLS
                                              • BOOKLETS
                                              • BROCHURES
                                              • FACT SHEETS13
                                              • TRAINING PRESENTATIONS13
                                              • WEB-BASED TRAINING13
                                              • SPECIAL INITIATIVES13
                                              • HELPFUL RESOURCES13
                                              • PROVIDER INDEX
                                              • SUBJECT INDEX

                                                22

                                                Official CMS Information for Medicare Fee-For-Service Providers

                                                httpwwwcmshhsgovMLNProducts

                                                Electronic Prescribing Incentive Program Electronic Prescribing Incentive Program (E-Prescribing) A fact sheet that provides an overview of the E-Prescribing Incentive Program as authorized by Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2 pages (October 2008) (ICN901263) Suggested For NPP Physicians

                                                2009 Electronic Prescribing (E-Prescribing) Incentive Program Made SimpleA fact sheet that provides a step-by-step guide to help eligible professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 4 pages (December 2008) (ICN901504) Suggested For NPP Physicians

                                                2009 Electronic Prescribing (E-Prescribing) Incentive Program Made Simple (Spanish Version)A fact sheet that provides a step-by-step guide to help the professionals determine their eligibility to participate in the E-Prescribing Incentive Program as well as provide guidance on the E-Prescribing process 2 pages (October 2008) (ICN901506) Suggested For Spanish Speaking NPP Spanish Speaking Physicians

                                                2009 Electronic Prescribing (E-Prescribing) Incentive Program Quick Reference ChartThis laminated reference chart summarizes the E-Prescribing options available 2-sided chart (January 2009) (ICN901505) Suggested For NPP Physicians

                                                ICD-10ICD-10-CM PCS BookmarkThis bookmark provides information about the ICD-10-Clinical ModificationProcedure Coding System (ICD-10-CMPCS) including the benefits of adopting the system recommended steps to be taken in order to plan and prepare for implementation of the system and where additional information about the system may be found 2-sided bookmark (August 2009) (ICN006946) Formats Available Hard Copy only Suggested For All Medicare Fee-For-Service Providers

                                                ICD-10 CM PCS Fact SheetThis fact sheet provides general information about the ICD-10-Clinical Modification Procedure Coding System including benefits of adopting the new coding system structural differences between ICD-9-CM and ICD-10-CM PCS and implementation planning recommendations 4 pages (August 2009) (ICN901044) Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                                ICD-10 CM PCS Myths amp FactsThis fact sheet presents correct information in response to some myths regarding the ICD-10 Clinical Modification Procedure Coding System (June 2009) (ICN902143)Suggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                                Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                                ldquoThe hyperlinks that take you directly to the publication when viewed in electronic format are very usefulrdquo ndash Provider Feedback Panel Member

                                                SPEC

                                                IAL

                                                INIT

                                                IATI

                                                VES

                                                httpwwwcmshhsgovMLNProducts

                                                23Official CMS Information for Medicare Fee-For-Service Providers

                                                General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                                Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                                Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                                2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                                2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                                PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                                2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                                2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                                2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                                SPECIAL INITIATIVES

                                                24

                                                Official CMS Information for Medicare Fee-For-Service Providers

                                                httpwwwcmshhsgovMLNProducts

                                                Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                                2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                                2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                                2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                                PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                                2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                                SPEC

                                                IAL

                                                INIT

                                                IATI

                                                VES

                                                ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                                httpwwwcmshhsgovMLNProducts

                                                25Official CMS Information for Medicare Fee-For-Service Providers

                                                Helpful Resources

                                                Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                                Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                                Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                                Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                                ICD-10httpwwwcmshhsgovICD10

                                                Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                                Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                                Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                                Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                                Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                                Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                                Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                                HELPFUL RESOURCES

                                                26

                                                Official CMS Information for Medicare Fee-For-Service Providers

                                                httpwwwcmshhsgovMLNProducts26

                                                All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                                All Institutional Providerspp 9 14 20 21

                                                All Part B Providerspp 11 13

                                                All Rural Providerspp 5 7 18 19

                                                Ambulance Supplierpp 10-12 17 20

                                                Ambulatory Surgical Center (ASC)pp 9 12

                                                Chiropractorp 12

                                                Clinics Group Practicespp 5 7-9 13

                                                Community Mental Health Centerp 14See All Institutional Providers

                                                Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                                Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                                Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                                Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                                End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                                Facilitatorpp 3 5 6

                                                Federally Qualified Health Center (FQHC)pp 18-19

                                                PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                                Hospicep 14

                                                Hospitalpp 3 7-9 12-15 16-20

                                                Indian Health Service Facility (IHS)pp 6 14 17

                                                Inpatient Rehabilitation Facilitypp 9 15

                                                Laboratory Independent Clinical (ICL)pp 7-9

                                                Long Term Care Hospital (LTCH)p 15

                                                Mammography Centerpp 7-8

                                                Medical Billers Coderspp 17 22 23

                                                Medicare Dependent Hospitalp 18

                                                NPP Non-Physician Practitionerpp 2 5-25

                                                Nurse Anesthetist (CRNA)pp 2 5-25

                                                Nurse Midwife (CNM)pp 2 5-25

                                                Nurse Practitioner (NP)pp 2 5-25

                                                Nurse Specialist (CNS)pp 2 5-25

                                                Pharmacy PharmacistSee Supplier

                                                Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                                PROV

                                                IDER

                                                INDE

                                                X

                                                httpwwwcmshhsgovMLNProducts

                                                27Official CMS Information for Medicare Fee-For-Service Providers 27

                                                Physicianpp 2 5-25

                                                Physician Assistant (PA)pp 2 5-25

                                                Psychologist Clinical See All Part B Providers

                                                Psychiatric HospitalSee Hospital

                                                Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                                Rural Health Clinic (RHC)p19See also All Rural Providers

                                                Rural Referral Center (RHC)p 19See also All Rural Providers

                                                Skilled Nursing Facility (SNF)pp 17 19 21

                                                Social Worker Clinicalp 7

                                                Sole Community Hospital p 19See All Rural Providers and Hospital

                                                Supplierpp 10-11 20

                                                Teacherpp 3 5 6

                                                X-Ray Facility Portablepp 7-8

                                                NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                                PROVIDER INDEX

                                                ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                                2828

                                                Official CMS Information for Medicare Fee-For-Service Providers

                                                httpwwwcmshhsgovMLNProducts

                                                SUBJ

                                                ECT

                                                INDE

                                                X

                                                Appealsp 10

                                                Articlesp 4

                                                AV Fistulap 20

                                                Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                                Bone Mass Measurementp 9

                                                Bookletsp 8

                                                Bookmarkspp 6 7 22

                                                Brochurespp 9-11

                                                Cancer p 9

                                                Certificate Of Medical Necessity (CMN)p 20

                                                Chiropracticp 12

                                                Claims Reviewp 8

                                                Clinical Laboratory Improvement Amendments (CLIA)p 9

                                                CMS Form 1500pp 13 20

                                                Diabetesp10

                                                Electronic Prescribing (E-Prescribing)pp 22 25

                                                Email Subscription Service p12

                                                Emergency Health Servicesp 17

                                                SUBJECT INDEXEnrollment Reportingp 13

                                                Evaluation And Management Services (EampM) p 2

                                                Fact Sheetspp 12-19 22-24

                                                Fee Schedulespp 12 16

                                                Fraud And Abusepp 16 21

                                                Glaucomap 10

                                                Guidespp 2 3 25

                                                Hospital Acquired Conditions (HAC)p 14

                                                Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                                Hospital Outpatient Prospective Payment System (OPPS)p 14

                                                ICD-9-CM Diagnosis Coding pp 20 23

                                                ICD-10-CM Procedure Codingp 23

                                                Immunizationpp 7 9

                                                Kidney Dialysis Transplant ESRDpp 2 16 20

                                                Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                                Manualsp 9

                                                Medicaidp 11

                                                httpwwwcmshhsgovMLNProducts

                                                29Official CMS Information for Medicare Fee-For-Service Providers

                                                SUBJECT INDEX

                                                29

                                                Medical Reviewp 11

                                                Medicarepp 21 25

                                                Medicare Learning Network (MLN)pp 4-6 18

                                                Medicare Remit Easy Print (MREP)p 10

                                                Medicare Secondary Payer (MSP)p 16

                                                Outpatient Code Editor (OCE)p 21

                                                Overpaymentsp 11

                                                Physical Examination (IPPE)pp 7 10

                                                Physician Fee Schedule (MPSF)p 16

                                                Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                Podiatry Servicesp 16

                                                Power Mobility Devices (PMDs)p 9

                                                Practice Managementpp 2-3 7 11-12 16 21

                                                Present On Admission (POA)p 17

                                                Preventive Servicespp 2 6-11 21

                                                Privacyp 16

                                                Prospective Payment Systemspp 12-15 17 20

                                                Quick Reference Chartspp 7 22 24

                                                Rehabilitation Therapy p 17

                                                Remittance Advice (RA)p 3

                                                Rural Healthpp 5 7 18-19

                                                Smoking Cessationp 11

                                                SNF Consolidated Billingp 21

                                                Special Initiativespp 22-24

                                                Spell Of Illnessp 7

                                                Swing Bedp 19

                                                Telehealth Servicesp 19

                                                UB-04pp 14 21

                                                Undocumented Aliensp 17

                                                Web Addresses Resourcespp 5 25

                                                Web-Based Trainingpp 20 21

                                                Womenrsquos Healthp 21

                                                Official CMS Information for Medicare Fee-For-Service Providers

                                                November 2009

                                                ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                R

                                                • INTRODUCTION13
                                                • TABLE OF CONTENTS
                                                • GUIDES
                                                • ARTICLES
                                                • EDUCATIONAL TOOLS
                                                • BOOKLETS
                                                • BROCHURES
                                                • FACT SHEETS13
                                                • TRAINING PRESENTATIONS13
                                                • WEB-BASED TRAINING13
                                                • SPECIAL INITIATIVES13
                                                • HELPFUL RESOURCES13
                                                • PROVIDER INDEX
                                                • SUBJECT INDEX

                                                  httpwwwcmshhsgovMLNProducts

                                                  23Official CMS Information for Medicare Fee-For-Service Providers

                                                  General Equivalence Mappings ndash ICD-9-CM To and From ICD-10-CM and ICD-10-PCS This fact sheet provides information and resources regarding the General Equivalence Mappings that were developed as a tool to assist with the conversion of International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes to International Classification of Diseases 10th Edition (ICD-10) and the conversion of ICD-10 codes back to ICD-9-CM 4 pages (March 2009) (ICN901743)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                                  Second in Series General Equivalence Mappings ndash ICD-9-CM to and From ICD-10-CM and ICD-10-PCS This fact sheet which is the second in the ICD-10 General Equivalence Mappings (GEM) Fact Sheet series provides basic information about the GEMs including possible users of the GEMs why the GEMs are needed and how the GEMs files are formatted as well as Reimbursement Mappings information (May 2009) (ICN901963)Formats Available Downloadable Hard CopySuggested For All Medicare Fee-For-Service Providers Medical Billers Medical Coders

                                                  Physician Quality Reporting InitiativePhysician Quality Reporting Initiative (PQRI) Tool KitCMS has developed a ldquoPQRI Tool Kit-Steps for Successrdquo that will assist eligible professionals with successful reporting as well as education of their staff This Tool Kit is also useful for group presentations and training programs Currently the Tool Kit consists of the two educational resources listed below Each resource in the tool kit is designed to stand alone or can be combined with the other resource for a training session tailored to the particular audience

                                                  2009 PQRI Single Source Code MasterA numerical listing of all codes included in PQRI for incorporation into billing software (December 2008)Suggested For NPP Physicians

                                                  2009 PQRI Data Collection WorksheetsMeasure-specific worksheets that walk the user step-by-step through reporting for each measure These worksheets may be used by the practice on a concurrent basis to collect PQRI data Suggested For NPP Physicians

                                                  PQRI Fact Sheets And Tip Sheets2009 PQRI Fact Sheet ndash Whatrsquos New For The 2009 Physician Quality Reporting InitiativeA fact sheet that provides an overview of the 2009 PQRI and highlights the changes from the 2008 PQRI program 8 pages (January 2009) (ICN901503) Suggested For NPP Physicians

                                                  2008 PQRI Fact Sheet ndash Program Overview A fact sheet that provides a program overview of the 2008 PQRI 2 pages (January 2008) (ICN006597) Suggested For NPP Physicians

                                                  2008 PQRI ndash New Reporting Options A fact sheet that provides an overview of reporting options for the 2008 PQRI including alternative reporting periods and alternative criteria for satisfactorily reporting 4 pages (April 2008) (ICN007018) Suggested For NPP Physicians

                                                  2009 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures GroupA tip sheet that provides quick easy-to-understand instructions on how to satisfactorily participate in the 2009 PQRI for those who wish to report quality data using claims for the Preventive Care Measures Group 4 pages (January 2009)(ICN901523) Suggested For NPP Physicians

                                                  SPECIAL INITIATIVES

                                                  24

                                                  Official CMS Information for Medicare Fee-For-Service Providers

                                                  httpwwwcmshhsgovMLNProducts

                                                  Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                                  2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                                  2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                                  2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                                  PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                                  2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                                  SPEC

                                                  IAL

                                                  INIT

                                                  IATI

                                                  VES

                                                  ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                                  httpwwwcmshhsgovMLNProducts

                                                  25Official CMS Information for Medicare Fee-For-Service Providers

                                                  Helpful Resources

                                                  Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                                  Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                                  Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                                  Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                                  ICD-10httpwwwcmshhsgovICD10

                                                  Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                                  Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                                  Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                                  Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                                  Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                                  Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                                  Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                                  HELPFUL RESOURCES

                                                  26

                                                  Official CMS Information for Medicare Fee-For-Service Providers

                                                  httpwwwcmshhsgovMLNProducts26

                                                  All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                                  All Institutional Providerspp 9 14 20 21

                                                  All Part B Providerspp 11 13

                                                  All Rural Providerspp 5 7 18 19

                                                  Ambulance Supplierpp 10-12 17 20

                                                  Ambulatory Surgical Center (ASC)pp 9 12

                                                  Chiropractorp 12

                                                  Clinics Group Practicespp 5 7-9 13

                                                  Community Mental Health Centerp 14See All Institutional Providers

                                                  Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                                  Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                                  Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                                  Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                                  End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                                  Facilitatorpp 3 5 6

                                                  Federally Qualified Health Center (FQHC)pp 18-19

                                                  PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                                  Hospicep 14

                                                  Hospitalpp 3 7-9 12-15 16-20

                                                  Indian Health Service Facility (IHS)pp 6 14 17

                                                  Inpatient Rehabilitation Facilitypp 9 15

                                                  Laboratory Independent Clinical (ICL)pp 7-9

                                                  Long Term Care Hospital (LTCH)p 15

                                                  Mammography Centerpp 7-8

                                                  Medical Billers Coderspp 17 22 23

                                                  Medicare Dependent Hospitalp 18

                                                  NPP Non-Physician Practitionerpp 2 5-25

                                                  Nurse Anesthetist (CRNA)pp 2 5-25

                                                  Nurse Midwife (CNM)pp 2 5-25

                                                  Nurse Practitioner (NP)pp 2 5-25

                                                  Nurse Specialist (CNS)pp 2 5-25

                                                  Pharmacy PharmacistSee Supplier

                                                  Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                                  PROV

                                                  IDER

                                                  INDE

                                                  X

                                                  httpwwwcmshhsgovMLNProducts

                                                  27Official CMS Information for Medicare Fee-For-Service Providers 27

                                                  Physicianpp 2 5-25

                                                  Physician Assistant (PA)pp 2 5-25

                                                  Psychologist Clinical See All Part B Providers

                                                  Psychiatric HospitalSee Hospital

                                                  Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                                  Rural Health Clinic (RHC)p19See also All Rural Providers

                                                  Rural Referral Center (RHC)p 19See also All Rural Providers

                                                  Skilled Nursing Facility (SNF)pp 17 19 21

                                                  Social Worker Clinicalp 7

                                                  Sole Community Hospital p 19See All Rural Providers and Hospital

                                                  Supplierpp 10-11 20

                                                  Teacherpp 3 5 6

                                                  X-Ray Facility Portablepp 7-8

                                                  NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                                  PROVIDER INDEX

                                                  ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                                  2828

                                                  Official CMS Information for Medicare Fee-For-Service Providers

                                                  httpwwwcmshhsgovMLNProducts

                                                  SUBJ

                                                  ECT

                                                  INDE

                                                  X

                                                  Appealsp 10

                                                  Articlesp 4

                                                  AV Fistulap 20

                                                  Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                                  Bone Mass Measurementp 9

                                                  Bookletsp 8

                                                  Bookmarkspp 6 7 22

                                                  Brochurespp 9-11

                                                  Cancer p 9

                                                  Certificate Of Medical Necessity (CMN)p 20

                                                  Chiropracticp 12

                                                  Claims Reviewp 8

                                                  Clinical Laboratory Improvement Amendments (CLIA)p 9

                                                  CMS Form 1500pp 13 20

                                                  Diabetesp10

                                                  Electronic Prescribing (E-Prescribing)pp 22 25

                                                  Email Subscription Service p12

                                                  Emergency Health Servicesp 17

                                                  SUBJECT INDEXEnrollment Reportingp 13

                                                  Evaluation And Management Services (EampM) p 2

                                                  Fact Sheetspp 12-19 22-24

                                                  Fee Schedulespp 12 16

                                                  Fraud And Abusepp 16 21

                                                  Glaucomap 10

                                                  Guidespp 2 3 25

                                                  Hospital Acquired Conditions (HAC)p 14

                                                  Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                                  Hospital Outpatient Prospective Payment System (OPPS)p 14

                                                  ICD-9-CM Diagnosis Coding pp 20 23

                                                  ICD-10-CM Procedure Codingp 23

                                                  Immunizationpp 7 9

                                                  Kidney Dialysis Transplant ESRDpp 2 16 20

                                                  Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                                  Manualsp 9

                                                  Medicaidp 11

                                                  httpwwwcmshhsgovMLNProducts

                                                  29Official CMS Information for Medicare Fee-For-Service Providers

                                                  SUBJECT INDEX

                                                  29

                                                  Medical Reviewp 11

                                                  Medicarepp 21 25

                                                  Medicare Learning Network (MLN)pp 4-6 18

                                                  Medicare Remit Easy Print (MREP)p 10

                                                  Medicare Secondary Payer (MSP)p 16

                                                  Outpatient Code Editor (OCE)p 21

                                                  Overpaymentsp 11

                                                  Physical Examination (IPPE)pp 7 10

                                                  Physician Fee Schedule (MPSF)p 16

                                                  Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                  Podiatry Servicesp 16

                                                  Power Mobility Devices (PMDs)p 9

                                                  Practice Managementpp 2-3 7 11-12 16 21

                                                  Present On Admission (POA)p 17

                                                  Preventive Servicespp 2 6-11 21

                                                  Privacyp 16

                                                  Prospective Payment Systemspp 12-15 17 20

                                                  Quick Reference Chartspp 7 22 24

                                                  Rehabilitation Therapy p 17

                                                  Remittance Advice (RA)p 3

                                                  Rural Healthpp 5 7 18-19

                                                  Smoking Cessationp 11

                                                  SNF Consolidated Billingp 21

                                                  Special Initiativespp 22-24

                                                  Spell Of Illnessp 7

                                                  Swing Bedp 19

                                                  Telehealth Servicesp 19

                                                  UB-04pp 14 21

                                                  Undocumented Aliensp 17

                                                  Web Addresses Resourcespp 5 25

                                                  Web-Based Trainingpp 20 21

                                                  Womenrsquos Healthp 21

                                                  Official CMS Information for Medicare Fee-For-Service Providers

                                                  November 2009

                                                  ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                  R

                                                  • INTRODUCTION13
                                                  • TABLE OF CONTENTS
                                                  • GUIDES
                                                  • ARTICLES
                                                  • EDUCATIONAL TOOLS
                                                  • BOOKLETS
                                                  • BROCHURES
                                                  • FACT SHEETS13
                                                  • TRAINING PRESENTATIONS13
                                                  • WEB-BASED TRAINING13
                                                  • SPECIAL INITIATIVES13
                                                  • HELPFUL RESOURCES13
                                                  • PROVIDER INDEX
                                                  • SUBJECT INDEX

                                                    24

                                                    Official CMS Information for Medicare Fee-For-Service Providers

                                                    httpwwwcmshhsgovMLNProducts

                                                    Special InitiativesAll Special Initiatives are available as Downloadable unless otherwise noted

                                                    2008 PQRI Tip Sheet ndash Successful Participation A tip sheet that provide tips on successful participation in 2008 PQRI 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                                    2008 PQRI Tip Sheet ndash Getting Started With Claims-Based Reporting Of Measures Groups A tip sheet that assists eligible professionals on how to implement claims-based reporting of measures groups and includes sample clinical scenarios for each of the four measures groups available in the 2008 PQRI 5 pages (June 2008) (ICN900943) Suggested For NPP Physicians

                                                    2008 PQRI Tip Sheet ndash PQRI Made Simple Reporting The Preventive Care Measures Group A tip sheet that provides quick easy-to-understand instructions on how to use this measures group 4 pages (July 2008) (ICN900963) Suggested For NPP Physicians

                                                    PQRI Educational Tools2008 PQRI New Reporting Options Quick Reference Chart This laminated reference chart summarizes the new reporting options available for the 2008 PQRI with their corresponding alternative reporting periods 1 page (May 2008) (ICN900843) Suggested For NPP Physicians

                                                    2008 PQRI Patient ndash Level Measures Reference List A reference list that details the many PQRI measures that require one-time reporting per patient per reporting period per eligible professional 1 page (January 2008) (ICN006958) Suggested For NPP Physicians

                                                    SPEC

                                                    IAL

                                                    INIT

                                                    IATI

                                                    VES

                                                    ldquoI like that the Catalog contains different types of toolsrdquo ndash Provider Feedback Panel Member

                                                    httpwwwcmshhsgovMLNProducts

                                                    25Official CMS Information for Medicare Fee-For-Service Providers

                                                    Helpful Resources

                                                    Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                                    Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                                    Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                                    Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                                    ICD-10httpwwwcmshhsgovICD10

                                                    Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                                    Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                                    Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                                    Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                                    Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                                    Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                                    Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                                    HELPFUL RESOURCES

                                                    26

                                                    Official CMS Information for Medicare Fee-For-Service Providers

                                                    httpwwwcmshhsgovMLNProducts26

                                                    All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                                    All Institutional Providerspp 9 14 20 21

                                                    All Part B Providerspp 11 13

                                                    All Rural Providerspp 5 7 18 19

                                                    Ambulance Supplierpp 10-12 17 20

                                                    Ambulatory Surgical Center (ASC)pp 9 12

                                                    Chiropractorp 12

                                                    Clinics Group Practicespp 5 7-9 13

                                                    Community Mental Health Centerp 14See All Institutional Providers

                                                    Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                                    Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                                    Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                                    Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                                    End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                                    Facilitatorpp 3 5 6

                                                    Federally Qualified Health Center (FQHC)pp 18-19

                                                    PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                                    Hospicep 14

                                                    Hospitalpp 3 7-9 12-15 16-20

                                                    Indian Health Service Facility (IHS)pp 6 14 17

                                                    Inpatient Rehabilitation Facilitypp 9 15

                                                    Laboratory Independent Clinical (ICL)pp 7-9

                                                    Long Term Care Hospital (LTCH)p 15

                                                    Mammography Centerpp 7-8

                                                    Medical Billers Coderspp 17 22 23

                                                    Medicare Dependent Hospitalp 18

                                                    NPP Non-Physician Practitionerpp 2 5-25

                                                    Nurse Anesthetist (CRNA)pp 2 5-25

                                                    Nurse Midwife (CNM)pp 2 5-25

                                                    Nurse Practitioner (NP)pp 2 5-25

                                                    Nurse Specialist (CNS)pp 2 5-25

                                                    Pharmacy PharmacistSee Supplier

                                                    Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                                    PROV

                                                    IDER

                                                    INDE

                                                    X

                                                    httpwwwcmshhsgovMLNProducts

                                                    27Official CMS Information for Medicare Fee-For-Service Providers 27

                                                    Physicianpp 2 5-25

                                                    Physician Assistant (PA)pp 2 5-25

                                                    Psychologist Clinical See All Part B Providers

                                                    Psychiatric HospitalSee Hospital

                                                    Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                                    Rural Health Clinic (RHC)p19See also All Rural Providers

                                                    Rural Referral Center (RHC)p 19See also All Rural Providers

                                                    Skilled Nursing Facility (SNF)pp 17 19 21

                                                    Social Worker Clinicalp 7

                                                    Sole Community Hospital p 19See All Rural Providers and Hospital

                                                    Supplierpp 10-11 20

                                                    Teacherpp 3 5 6

                                                    X-Ray Facility Portablepp 7-8

                                                    NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                                    PROVIDER INDEX

                                                    ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                                    2828

                                                    Official CMS Information for Medicare Fee-For-Service Providers

                                                    httpwwwcmshhsgovMLNProducts

                                                    SUBJ

                                                    ECT

                                                    INDE

                                                    X

                                                    Appealsp 10

                                                    Articlesp 4

                                                    AV Fistulap 20

                                                    Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                                    Bone Mass Measurementp 9

                                                    Bookletsp 8

                                                    Bookmarkspp 6 7 22

                                                    Brochurespp 9-11

                                                    Cancer p 9

                                                    Certificate Of Medical Necessity (CMN)p 20

                                                    Chiropracticp 12

                                                    Claims Reviewp 8

                                                    Clinical Laboratory Improvement Amendments (CLIA)p 9

                                                    CMS Form 1500pp 13 20

                                                    Diabetesp10

                                                    Electronic Prescribing (E-Prescribing)pp 22 25

                                                    Email Subscription Service p12

                                                    Emergency Health Servicesp 17

                                                    SUBJECT INDEXEnrollment Reportingp 13

                                                    Evaluation And Management Services (EampM) p 2

                                                    Fact Sheetspp 12-19 22-24

                                                    Fee Schedulespp 12 16

                                                    Fraud And Abusepp 16 21

                                                    Glaucomap 10

                                                    Guidespp 2 3 25

                                                    Hospital Acquired Conditions (HAC)p 14

                                                    Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                                    Hospital Outpatient Prospective Payment System (OPPS)p 14

                                                    ICD-9-CM Diagnosis Coding pp 20 23

                                                    ICD-10-CM Procedure Codingp 23

                                                    Immunizationpp 7 9

                                                    Kidney Dialysis Transplant ESRDpp 2 16 20

                                                    Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                                    Manualsp 9

                                                    Medicaidp 11

                                                    httpwwwcmshhsgovMLNProducts

                                                    29Official CMS Information for Medicare Fee-For-Service Providers

                                                    SUBJECT INDEX

                                                    29

                                                    Medical Reviewp 11

                                                    Medicarepp 21 25

                                                    Medicare Learning Network (MLN)pp 4-6 18

                                                    Medicare Remit Easy Print (MREP)p 10

                                                    Medicare Secondary Payer (MSP)p 16

                                                    Outpatient Code Editor (OCE)p 21

                                                    Overpaymentsp 11

                                                    Physical Examination (IPPE)pp 7 10

                                                    Physician Fee Schedule (MPSF)p 16

                                                    Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                    Podiatry Servicesp 16

                                                    Power Mobility Devices (PMDs)p 9

                                                    Practice Managementpp 2-3 7 11-12 16 21

                                                    Present On Admission (POA)p 17

                                                    Preventive Servicespp 2 6-11 21

                                                    Privacyp 16

                                                    Prospective Payment Systemspp 12-15 17 20

                                                    Quick Reference Chartspp 7 22 24

                                                    Rehabilitation Therapy p 17

                                                    Remittance Advice (RA)p 3

                                                    Rural Healthpp 5 7 18-19

                                                    Smoking Cessationp 11

                                                    SNF Consolidated Billingp 21

                                                    Special Initiativespp 22-24

                                                    Spell Of Illnessp 7

                                                    Swing Bedp 19

                                                    Telehealth Servicesp 19

                                                    UB-04pp 14 21

                                                    Undocumented Aliensp 17

                                                    Web Addresses Resourcespp 5 25

                                                    Web-Based Trainingpp 20 21

                                                    Womenrsquos Healthp 21

                                                    Official CMS Information for Medicare Fee-For-Service Providers

                                                    November 2009

                                                    ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                    R

                                                    • INTRODUCTION13
                                                    • TABLE OF CONTENTS
                                                    • GUIDES
                                                    • ARTICLES
                                                    • EDUCATIONAL TOOLS
                                                    • BOOKLETS
                                                    • BROCHURES
                                                    • FACT SHEETS13
                                                    • TRAINING PRESENTATIONS13
                                                    • WEB-BASED TRAINING13
                                                    • SPECIAL INITIATIVES13
                                                    • HELPFUL RESOURCES13
                                                    • PROVIDER INDEX
                                                    • SUBJECT INDEX

                                                      httpwwwcmshhsgovMLNProducts

                                                      25Official CMS Information for Medicare Fee-For-Service Providers

                                                      Helpful Resources

                                                      Web ResourcesThe web pages listed below will provide ldquoOne-Stop Shoppingrdquo for information on the following CMS initiatives Advanced Practice Nursing Physician Assistant Durable Medical Equipment Prosthetics Orthotics and Supplies E-Prescribing Incentive Program ICD-10 Ophthalmology Resource Information and the Physician Quality Reporting Initiative All are available from the CMS website

                                                      Advanced Practice Nursing Physician Assistant (APN PA)httpwwwcmshhsgovMLNProducts70_APNPAasp

                                                      Durable Medical Equipment Prosthetics Orthotics and Supplieshttpwwwcmshhsgovcenterdmeasp

                                                      Electronic Prescribing Incentive Programhttpwwwcmshhsgoverxincentive

                                                      ICD-10httpwwwcmshhsgovICD10

                                                      Ophthalmology Resource InformationhttpwwwcmshhsgovMLNProducts65_ophthalmologyasp

                                                      Physician Quality Reporting InitiativehttpwwwcmshhsgovPQRI

                                                      Educational GuidesGuided PathwaysThese Guided Pathways booklets include fundamental information about Medicare as well as detailed policies and requirements The booklets incorporate existing Medicare Learning Network (MLN) products and other CMS resources into well organized topics and guide users to other related information sources (April 2009) (ICN006823)

                                                      Visit The Guided Pathways lsquoOne-Stop Shoppingrsquo Page athttpwwwcmshhsgovMLNEdWebGuide30_Guided_Pathwaysasp on the CMS website or select a booklet below

                                                      Basic Curriculum For Health Care Professionals Suppliers And Providers httpwwwcmshhsgovMLNEdWebGuide DownloadsGuided_Pathways_Basic_Bookletpdf29 pages

                                                      Intermediate Curriculum For Health Care Providers Part A BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartA_Bookletpdf26 pages

                                                      Intermediate Curriculum For Health Care Professionals And Suppliers Part B BooklethttpwwwcmshhsgovMLNEdWebGuideDownloadsGuided_Pathways_Intermediate_PartB_Bookletpdf37 pages

                                                      HELPFUL RESOURCES

                                                      26

                                                      Official CMS Information for Medicare Fee-For-Service Providers

                                                      httpwwwcmshhsgovMLNProducts26

                                                      All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                                      All Institutional Providerspp 9 14 20 21

                                                      All Part B Providerspp 11 13

                                                      All Rural Providerspp 5 7 18 19

                                                      Ambulance Supplierpp 10-12 17 20

                                                      Ambulatory Surgical Center (ASC)pp 9 12

                                                      Chiropractorp 12

                                                      Clinics Group Practicespp 5 7-9 13

                                                      Community Mental Health Centerp 14See All Institutional Providers

                                                      Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                                      Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                                      Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                                      Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                                      End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                                      Facilitatorpp 3 5 6

                                                      Federally Qualified Health Center (FQHC)pp 18-19

                                                      PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                                      Hospicep 14

                                                      Hospitalpp 3 7-9 12-15 16-20

                                                      Indian Health Service Facility (IHS)pp 6 14 17

                                                      Inpatient Rehabilitation Facilitypp 9 15

                                                      Laboratory Independent Clinical (ICL)pp 7-9

                                                      Long Term Care Hospital (LTCH)p 15

                                                      Mammography Centerpp 7-8

                                                      Medical Billers Coderspp 17 22 23

                                                      Medicare Dependent Hospitalp 18

                                                      NPP Non-Physician Practitionerpp 2 5-25

                                                      Nurse Anesthetist (CRNA)pp 2 5-25

                                                      Nurse Midwife (CNM)pp 2 5-25

                                                      Nurse Practitioner (NP)pp 2 5-25

                                                      Nurse Specialist (CNS)pp 2 5-25

                                                      Pharmacy PharmacistSee Supplier

                                                      Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                                      PROV

                                                      IDER

                                                      INDE

                                                      X

                                                      httpwwwcmshhsgovMLNProducts

                                                      27Official CMS Information for Medicare Fee-For-Service Providers 27

                                                      Physicianpp 2 5-25

                                                      Physician Assistant (PA)pp 2 5-25

                                                      Psychologist Clinical See All Part B Providers

                                                      Psychiatric HospitalSee Hospital

                                                      Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                                      Rural Health Clinic (RHC)p19See also All Rural Providers

                                                      Rural Referral Center (RHC)p 19See also All Rural Providers

                                                      Skilled Nursing Facility (SNF)pp 17 19 21

                                                      Social Worker Clinicalp 7

                                                      Sole Community Hospital p 19See All Rural Providers and Hospital

                                                      Supplierpp 10-11 20

                                                      Teacherpp 3 5 6

                                                      X-Ray Facility Portablepp 7-8

                                                      NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                                      PROVIDER INDEX

                                                      ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                                      2828

                                                      Official CMS Information for Medicare Fee-For-Service Providers

                                                      httpwwwcmshhsgovMLNProducts

                                                      SUBJ

                                                      ECT

                                                      INDE

                                                      X

                                                      Appealsp 10

                                                      Articlesp 4

                                                      AV Fistulap 20

                                                      Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                                      Bone Mass Measurementp 9

                                                      Bookletsp 8

                                                      Bookmarkspp 6 7 22

                                                      Brochurespp 9-11

                                                      Cancer p 9

                                                      Certificate Of Medical Necessity (CMN)p 20

                                                      Chiropracticp 12

                                                      Claims Reviewp 8

                                                      Clinical Laboratory Improvement Amendments (CLIA)p 9

                                                      CMS Form 1500pp 13 20

                                                      Diabetesp10

                                                      Electronic Prescribing (E-Prescribing)pp 22 25

                                                      Email Subscription Service p12

                                                      Emergency Health Servicesp 17

                                                      SUBJECT INDEXEnrollment Reportingp 13

                                                      Evaluation And Management Services (EampM) p 2

                                                      Fact Sheetspp 12-19 22-24

                                                      Fee Schedulespp 12 16

                                                      Fraud And Abusepp 16 21

                                                      Glaucomap 10

                                                      Guidespp 2 3 25

                                                      Hospital Acquired Conditions (HAC)p 14

                                                      Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                                      Hospital Outpatient Prospective Payment System (OPPS)p 14

                                                      ICD-9-CM Diagnosis Coding pp 20 23

                                                      ICD-10-CM Procedure Codingp 23

                                                      Immunizationpp 7 9

                                                      Kidney Dialysis Transplant ESRDpp 2 16 20

                                                      Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                                      Manualsp 9

                                                      Medicaidp 11

                                                      httpwwwcmshhsgovMLNProducts

                                                      29Official CMS Information for Medicare Fee-For-Service Providers

                                                      SUBJECT INDEX

                                                      29

                                                      Medical Reviewp 11

                                                      Medicarepp 21 25

                                                      Medicare Learning Network (MLN)pp 4-6 18

                                                      Medicare Remit Easy Print (MREP)p 10

                                                      Medicare Secondary Payer (MSP)p 16

                                                      Outpatient Code Editor (OCE)p 21

                                                      Overpaymentsp 11

                                                      Physical Examination (IPPE)pp 7 10

                                                      Physician Fee Schedule (MPSF)p 16

                                                      Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                      Podiatry Servicesp 16

                                                      Power Mobility Devices (PMDs)p 9

                                                      Practice Managementpp 2-3 7 11-12 16 21

                                                      Present On Admission (POA)p 17

                                                      Preventive Servicespp 2 6-11 21

                                                      Privacyp 16

                                                      Prospective Payment Systemspp 12-15 17 20

                                                      Quick Reference Chartspp 7 22 24

                                                      Rehabilitation Therapy p 17

                                                      Remittance Advice (RA)p 3

                                                      Rural Healthpp 5 7 18-19

                                                      Smoking Cessationp 11

                                                      SNF Consolidated Billingp 21

                                                      Special Initiativespp 22-24

                                                      Spell Of Illnessp 7

                                                      Swing Bedp 19

                                                      Telehealth Servicesp 19

                                                      UB-04pp 14 21

                                                      Undocumented Aliensp 17

                                                      Web Addresses Resourcespp 5 25

                                                      Web-Based Trainingpp 20 21

                                                      Womenrsquos Healthp 21

                                                      Official CMS Information for Medicare Fee-For-Service Providers

                                                      November 2009

                                                      ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                      R

                                                      • INTRODUCTION13
                                                      • TABLE OF CONTENTS
                                                      • GUIDES
                                                      • ARTICLES
                                                      • EDUCATIONAL TOOLS
                                                      • BOOKLETS
                                                      • BROCHURES
                                                      • FACT SHEETS13
                                                      • TRAINING PRESENTATIONS13
                                                      • WEB-BASED TRAINING13
                                                      • SPECIAL INITIATIVES13
                                                      • HELPFUL RESOURCES13
                                                      • PROVIDER INDEX
                                                      • SUBJECT INDEX

                                                        26

                                                        Official CMS Information for Medicare Fee-For-Service Providers

                                                        httpwwwcmshhsgovMLNProducts26

                                                        All Medicare Fee-For-Service Providerspp 2-12 16-23 25

                                                        All Institutional Providerspp 9 14 20 21

                                                        All Part B Providerspp 11 13

                                                        All Rural Providerspp 5 7 18 19

                                                        Ambulance Supplierpp 10-12 17 20

                                                        Ambulatory Surgical Center (ASC)pp 9 12

                                                        Chiropractorp 12

                                                        Clinics Group Practicespp 5 7-9 13

                                                        Community Mental Health Centerp 14See All Institutional Providers

                                                        Comprehensive Outpatient Rehabilitation Facility (CORF)pp 9 15 17

                                                        Critical Access Hospital (CAH)pp 5 14 18 19 See also Hospital

                                                        Diagnostic Testing Facility Independent (IDTF)pp 7-9

                                                        Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS)pp 9-11 16 20 21 25

                                                        End Stage Renal Disease Facility (ESRD)pp 9 16 20

                                                        Facilitatorpp 3 5 6

                                                        Federally Qualified Health Center (FQHC)pp 18-19

                                                        PROVIDER INDEX Home Health Agency (HHA)pp 5 13-14

                                                        Hospicep 14

                                                        Hospitalpp 3 7-9 12-15 16-20

                                                        Indian Health Service Facility (IHS)pp 6 14 17

                                                        Inpatient Rehabilitation Facilitypp 9 15

                                                        Laboratory Independent Clinical (ICL)pp 7-9

                                                        Long Term Care Hospital (LTCH)p 15

                                                        Mammography Centerpp 7-8

                                                        Medical Billers Coderspp 17 22 23

                                                        Medicare Dependent Hospitalp 18

                                                        NPP Non-Physician Practitionerpp 2 5-25

                                                        Nurse Anesthetist (CRNA)pp 2 5-25

                                                        Nurse Midwife (CNM)pp 2 5-25

                                                        Nurse Practitioner (NP)pp 2 5-25

                                                        Nurse Specialist (CNS)pp 2 5-25

                                                        Pharmacy PharmacistSee Supplier

                                                        Physical Therapy (PT) Occupational Therapy (OT) Speech Language Pathology Services (SPL)p 17

                                                        PROV

                                                        IDER

                                                        INDE

                                                        X

                                                        httpwwwcmshhsgovMLNProducts

                                                        27Official CMS Information for Medicare Fee-For-Service Providers 27

                                                        Physicianpp 2 5-25

                                                        Physician Assistant (PA)pp 2 5-25

                                                        Psychologist Clinical See All Part B Providers

                                                        Psychiatric HospitalSee Hospital

                                                        Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                                        Rural Health Clinic (RHC)p19See also All Rural Providers

                                                        Rural Referral Center (RHC)p 19See also All Rural Providers

                                                        Skilled Nursing Facility (SNF)pp 17 19 21

                                                        Social Worker Clinicalp 7

                                                        Sole Community Hospital p 19See All Rural Providers and Hospital

                                                        Supplierpp 10-11 20

                                                        Teacherpp 3 5 6

                                                        X-Ray Facility Portablepp 7-8

                                                        NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                                        PROVIDER INDEX

                                                        ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                                        2828

                                                        Official CMS Information for Medicare Fee-For-Service Providers

                                                        httpwwwcmshhsgovMLNProducts

                                                        SUBJ

                                                        ECT

                                                        INDE

                                                        X

                                                        Appealsp 10

                                                        Articlesp 4

                                                        AV Fistulap 20

                                                        Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                                        Bone Mass Measurementp 9

                                                        Bookletsp 8

                                                        Bookmarkspp 6 7 22

                                                        Brochurespp 9-11

                                                        Cancer p 9

                                                        Certificate Of Medical Necessity (CMN)p 20

                                                        Chiropracticp 12

                                                        Claims Reviewp 8

                                                        Clinical Laboratory Improvement Amendments (CLIA)p 9

                                                        CMS Form 1500pp 13 20

                                                        Diabetesp10

                                                        Electronic Prescribing (E-Prescribing)pp 22 25

                                                        Email Subscription Service p12

                                                        Emergency Health Servicesp 17

                                                        SUBJECT INDEXEnrollment Reportingp 13

                                                        Evaluation And Management Services (EampM) p 2

                                                        Fact Sheetspp 12-19 22-24

                                                        Fee Schedulespp 12 16

                                                        Fraud And Abusepp 16 21

                                                        Glaucomap 10

                                                        Guidespp 2 3 25

                                                        Hospital Acquired Conditions (HAC)p 14

                                                        Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                                        Hospital Outpatient Prospective Payment System (OPPS)p 14

                                                        ICD-9-CM Diagnosis Coding pp 20 23

                                                        ICD-10-CM Procedure Codingp 23

                                                        Immunizationpp 7 9

                                                        Kidney Dialysis Transplant ESRDpp 2 16 20

                                                        Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                                        Manualsp 9

                                                        Medicaidp 11

                                                        httpwwwcmshhsgovMLNProducts

                                                        29Official CMS Information for Medicare Fee-For-Service Providers

                                                        SUBJECT INDEX

                                                        29

                                                        Medical Reviewp 11

                                                        Medicarepp 21 25

                                                        Medicare Learning Network (MLN)pp 4-6 18

                                                        Medicare Remit Easy Print (MREP)p 10

                                                        Medicare Secondary Payer (MSP)p 16

                                                        Outpatient Code Editor (OCE)p 21

                                                        Overpaymentsp 11

                                                        Physical Examination (IPPE)pp 7 10

                                                        Physician Fee Schedule (MPSF)p 16

                                                        Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                        Podiatry Servicesp 16

                                                        Power Mobility Devices (PMDs)p 9

                                                        Practice Managementpp 2-3 7 11-12 16 21

                                                        Present On Admission (POA)p 17

                                                        Preventive Servicespp 2 6-11 21

                                                        Privacyp 16

                                                        Prospective Payment Systemspp 12-15 17 20

                                                        Quick Reference Chartspp 7 22 24

                                                        Rehabilitation Therapy p 17

                                                        Remittance Advice (RA)p 3

                                                        Rural Healthpp 5 7 18-19

                                                        Smoking Cessationp 11

                                                        SNF Consolidated Billingp 21

                                                        Special Initiativespp 22-24

                                                        Spell Of Illnessp 7

                                                        Swing Bedp 19

                                                        Telehealth Servicesp 19

                                                        UB-04pp 14 21

                                                        Undocumented Aliensp 17

                                                        Web Addresses Resourcespp 5 25

                                                        Web-Based Trainingpp 20 21

                                                        Womenrsquos Healthp 21

                                                        Official CMS Information for Medicare Fee-For-Service Providers

                                                        November 2009

                                                        ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                        R

                                                        • INTRODUCTION13
                                                        • TABLE OF CONTENTS
                                                        • GUIDES
                                                        • ARTICLES
                                                        • EDUCATIONAL TOOLS
                                                        • BOOKLETS
                                                        • BROCHURES
                                                        • FACT SHEETS13
                                                        • TRAINING PRESENTATIONS13
                                                        • WEB-BASED TRAINING13
                                                        • SPECIAL INITIATIVES13
                                                        • HELPFUL RESOURCES13
                                                        • PROVIDER INDEX
                                                        • SUBJECT INDEX

                                                          httpwwwcmshhsgovMLNProducts

                                                          27Official CMS Information for Medicare Fee-For-Service Providers 27

                                                          Physicianpp 2 5-25

                                                          Physician Assistant (PA)pp 2 5-25

                                                          Psychologist Clinical See All Part B Providers

                                                          Psychiatric HospitalSee Hospital

                                                          Religious Non-Medical Health Care Institution (RNMHI)See All Institutional Providers

                                                          Rural Health Clinic (RHC)p19See also All Rural Providers

                                                          Rural Referral Center (RHC)p 19See also All Rural Providers

                                                          Skilled Nursing Facility (SNF)pp 17 19 21

                                                          Social Worker Clinicalp 7

                                                          Sole Community Hospital p 19See All Rural Providers and Hospital

                                                          Supplierpp 10-11 20

                                                          Teacherpp 3 5 6

                                                          X-Ray Facility Portablepp 7-8

                                                          NPP includes Nurse Anesthetist Nurse Midwife Nurse Practitioner Nurse Specialist Physician Assistant and at times certain other health care practitioners

                                                          PROVIDER INDEX

                                                          ldquoThe Catalog is probably the best lsquoproductrsquo CMS has for the FFS provider communityrdquo ndash Provider Feedback Panel Member

                                                          2828

                                                          Official CMS Information for Medicare Fee-For-Service Providers

                                                          httpwwwcmshhsgovMLNProducts

                                                          SUBJ

                                                          ECT

                                                          INDE

                                                          X

                                                          Appealsp 10

                                                          Articlesp 4

                                                          AV Fistulap 20

                                                          Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                                          Bone Mass Measurementp 9

                                                          Bookletsp 8

                                                          Bookmarkspp 6 7 22

                                                          Brochurespp 9-11

                                                          Cancer p 9

                                                          Certificate Of Medical Necessity (CMN)p 20

                                                          Chiropracticp 12

                                                          Claims Reviewp 8

                                                          Clinical Laboratory Improvement Amendments (CLIA)p 9

                                                          CMS Form 1500pp 13 20

                                                          Diabetesp10

                                                          Electronic Prescribing (E-Prescribing)pp 22 25

                                                          Email Subscription Service p12

                                                          Emergency Health Servicesp 17

                                                          SUBJECT INDEXEnrollment Reportingp 13

                                                          Evaluation And Management Services (EampM) p 2

                                                          Fact Sheetspp 12-19 22-24

                                                          Fee Schedulespp 12 16

                                                          Fraud And Abusepp 16 21

                                                          Glaucomap 10

                                                          Guidespp 2 3 25

                                                          Hospital Acquired Conditions (HAC)p 14

                                                          Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                                          Hospital Outpatient Prospective Payment System (OPPS)p 14

                                                          ICD-9-CM Diagnosis Coding pp 20 23

                                                          ICD-10-CM Procedure Codingp 23

                                                          Immunizationpp 7 9

                                                          Kidney Dialysis Transplant ESRDpp 2 16 20

                                                          Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                                          Manualsp 9

                                                          Medicaidp 11

                                                          httpwwwcmshhsgovMLNProducts

                                                          29Official CMS Information for Medicare Fee-For-Service Providers

                                                          SUBJECT INDEX

                                                          29

                                                          Medical Reviewp 11

                                                          Medicarepp 21 25

                                                          Medicare Learning Network (MLN)pp 4-6 18

                                                          Medicare Remit Easy Print (MREP)p 10

                                                          Medicare Secondary Payer (MSP)p 16

                                                          Outpatient Code Editor (OCE)p 21

                                                          Overpaymentsp 11

                                                          Physical Examination (IPPE)pp 7 10

                                                          Physician Fee Schedule (MPSF)p 16

                                                          Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                          Podiatry Servicesp 16

                                                          Power Mobility Devices (PMDs)p 9

                                                          Practice Managementpp 2-3 7 11-12 16 21

                                                          Present On Admission (POA)p 17

                                                          Preventive Servicespp 2 6-11 21

                                                          Privacyp 16

                                                          Prospective Payment Systemspp 12-15 17 20

                                                          Quick Reference Chartspp 7 22 24

                                                          Rehabilitation Therapy p 17

                                                          Remittance Advice (RA)p 3

                                                          Rural Healthpp 5 7 18-19

                                                          Smoking Cessationp 11

                                                          SNF Consolidated Billingp 21

                                                          Special Initiativespp 22-24

                                                          Spell Of Illnessp 7

                                                          Swing Bedp 19

                                                          Telehealth Servicesp 19

                                                          UB-04pp 14 21

                                                          Undocumented Aliensp 17

                                                          Web Addresses Resourcespp 5 25

                                                          Web-Based Trainingpp 20 21

                                                          Womenrsquos Healthp 21

                                                          Official CMS Information for Medicare Fee-For-Service Providers

                                                          November 2009

                                                          ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                          R

                                                          • INTRODUCTION13
                                                          • TABLE OF CONTENTS
                                                          • GUIDES
                                                          • ARTICLES
                                                          • EDUCATIONAL TOOLS
                                                          • BOOKLETS
                                                          • BROCHURES
                                                          • FACT SHEETS13
                                                          • TRAINING PRESENTATIONS13
                                                          • WEB-BASED TRAINING13
                                                          • SPECIAL INITIATIVES13
                                                          • HELPFUL RESOURCES13
                                                          • PROVIDER INDEX
                                                          • SUBJECT INDEX

                                                            2828

                                                            Official CMS Information for Medicare Fee-For-Service Providers

                                                            httpwwwcmshhsgovMLNProducts

                                                            SUBJ

                                                            ECT

                                                            INDE

                                                            X

                                                            Appealsp 10

                                                            Articlesp 4

                                                            AV Fistulap 20

                                                            Billing Informationpp 2-5 7 8 10-11 13 14 16-17 20-21

                                                            Bone Mass Measurementp 9

                                                            Bookletsp 8

                                                            Bookmarkspp 6 7 22

                                                            Brochurespp 9-11

                                                            Cancer p 9

                                                            Certificate Of Medical Necessity (CMN)p 20

                                                            Chiropracticp 12

                                                            Claims Reviewp 8

                                                            Clinical Laboratory Improvement Amendments (CLIA)p 9

                                                            CMS Form 1500pp 13 20

                                                            Diabetesp10

                                                            Electronic Prescribing (E-Prescribing)pp 22 25

                                                            Email Subscription Service p12

                                                            Emergency Health Servicesp 17

                                                            SUBJECT INDEXEnrollment Reportingp 13

                                                            Evaluation And Management Services (EampM) p 2

                                                            Fact Sheetspp 12-19 22-24

                                                            Fee Schedulespp 12 16

                                                            Fraud And Abusepp 16 21

                                                            Glaucomap 10

                                                            Guidespp 2 3 25

                                                            Hospital Acquired Conditions (HAC)p 14

                                                            Hospital Inpatient Prospective Payment System (IPPS)pp 12 20

                                                            Hospital Outpatient Prospective Payment System (OPPS)p 14

                                                            ICD-9-CM Diagnosis Coding pp 20 23

                                                            ICD-10-CM Procedure Codingp 23

                                                            Immunizationpp 7 9

                                                            Kidney Dialysis Transplant ESRDpp 2 16 20

                                                            Long Term Care Hospital Prospective Payment System (LTCH PPS)p 15

                                                            Manualsp 9

                                                            Medicaidp 11

                                                            httpwwwcmshhsgovMLNProducts

                                                            29Official CMS Information for Medicare Fee-For-Service Providers

                                                            SUBJECT INDEX

                                                            29

                                                            Medical Reviewp 11

                                                            Medicarepp 21 25

                                                            Medicare Learning Network (MLN)pp 4-6 18

                                                            Medicare Remit Easy Print (MREP)p 10

                                                            Medicare Secondary Payer (MSP)p 16

                                                            Outpatient Code Editor (OCE)p 21

                                                            Overpaymentsp 11

                                                            Physical Examination (IPPE)pp 7 10

                                                            Physician Fee Schedule (MPSF)p 16

                                                            Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                            Podiatry Servicesp 16

                                                            Power Mobility Devices (PMDs)p 9

                                                            Practice Managementpp 2-3 7 11-12 16 21

                                                            Present On Admission (POA)p 17

                                                            Preventive Servicespp 2 6-11 21

                                                            Privacyp 16

                                                            Prospective Payment Systemspp 12-15 17 20

                                                            Quick Reference Chartspp 7 22 24

                                                            Rehabilitation Therapy p 17

                                                            Remittance Advice (RA)p 3

                                                            Rural Healthpp 5 7 18-19

                                                            Smoking Cessationp 11

                                                            SNF Consolidated Billingp 21

                                                            Special Initiativespp 22-24

                                                            Spell Of Illnessp 7

                                                            Swing Bedp 19

                                                            Telehealth Servicesp 19

                                                            UB-04pp 14 21

                                                            Undocumented Aliensp 17

                                                            Web Addresses Resourcespp 5 25

                                                            Web-Based Trainingpp 20 21

                                                            Womenrsquos Healthp 21

                                                            Official CMS Information for Medicare Fee-For-Service Providers

                                                            November 2009

                                                            ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                            R

                                                            • INTRODUCTION13
                                                            • TABLE OF CONTENTS
                                                            • GUIDES
                                                            • ARTICLES
                                                            • EDUCATIONAL TOOLS
                                                            • BOOKLETS
                                                            • BROCHURES
                                                            • FACT SHEETS13
                                                            • TRAINING PRESENTATIONS13
                                                            • WEB-BASED TRAINING13
                                                            • SPECIAL INITIATIVES13
                                                            • HELPFUL RESOURCES13
                                                            • PROVIDER INDEX
                                                            • SUBJECT INDEX

                                                              httpwwwcmshhsgovMLNProducts

                                                              29Official CMS Information for Medicare Fee-For-Service Providers

                                                              SUBJECT INDEX

                                                              29

                                                              Medical Reviewp 11

                                                              Medicarepp 21 25

                                                              Medicare Learning Network (MLN)pp 4-6 18

                                                              Medicare Remit Easy Print (MREP)p 10

                                                              Medicare Secondary Payer (MSP)p 16

                                                              Outpatient Code Editor (OCE)p 21

                                                              Overpaymentsp 11

                                                              Physical Examination (IPPE)pp 7 10

                                                              Physician Fee Schedule (MPSF)p 16

                                                              Physician Quality Reporting Initiative (PQRI)pp 21 23 24

                                                              Podiatry Servicesp 16

                                                              Power Mobility Devices (PMDs)p 9

                                                              Practice Managementpp 2-3 7 11-12 16 21

                                                              Present On Admission (POA)p 17

                                                              Preventive Servicespp 2 6-11 21

                                                              Privacyp 16

                                                              Prospective Payment Systemspp 12-15 17 20

                                                              Quick Reference Chartspp 7 22 24

                                                              Rehabilitation Therapy p 17

                                                              Remittance Advice (RA)p 3

                                                              Rural Healthpp 5 7 18-19

                                                              Smoking Cessationp 11

                                                              SNF Consolidated Billingp 21

                                                              Special Initiativespp 22-24

                                                              Spell Of Illnessp 7

                                                              Swing Bedp 19

                                                              Telehealth Servicesp 19

                                                              UB-04pp 14 21

                                                              Undocumented Aliensp 17

                                                              Web Addresses Resourcespp 5 25

                                                              Web-Based Trainingpp 20 21

                                                              Womenrsquos Healthp 21

                                                              Official CMS Information for Medicare Fee-For-Service Providers

                                                              November 2009

                                                              ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                              R

                                                              • INTRODUCTION13
                                                              • TABLE OF CONTENTS
                                                              • GUIDES
                                                              • ARTICLES
                                                              • EDUCATIONAL TOOLS
                                                              • BOOKLETS
                                                              • BROCHURES
                                                              • FACT SHEETS13
                                                              • TRAINING PRESENTATIONS13
                                                              • WEB-BASED TRAINING13
                                                              • SPECIAL INITIATIVES13
                                                              • HELPFUL RESOURCES13
                                                              • PROVIDER INDEX
                                                              • SUBJECT INDEX

                                                                Official CMS Information for Medicare Fee-For-Service Providers

                                                                November 2009

                                                                ICN006823 Official CMS Information forMedicare Fee-For-Service Providers

                                                                R

                                                                • INTRODUCTION13
                                                                • TABLE OF CONTENTS
                                                                • GUIDES
                                                                • ARTICLES
                                                                • EDUCATIONAL TOOLS
                                                                • BOOKLETS
                                                                • BROCHURES
                                                                • FACT SHEETS13
                                                                • TRAINING PRESENTATIONS13
                                                                • WEB-BASED TRAINING13
                                                                • SPECIAL INITIATIVES13
                                                                • HELPFUL RESOURCES13
                                                                • PROVIDER INDEX
                                                                • SUBJECT INDEX

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