Wiki New to Medicare Billing and Guidlines

[charbanc]

Hello,

Where would someone be able to find medicare guidelines for billing and what is reimbursed per code? And how to remain compliant with Medicare?

 

[ellzeycoding]

In the BROAD scope of things...

Here is a link the the CMS Claims Processing Manuals online (it's very technical)

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

And there are fee look-up tools available on the CMS website as well...

https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

You can also download fee schedules from the various state Medicare carriers. (Fees vary by Medicare locality and region).

For example, Noridian is one of the CMS claim carriers...

https://med.noridianmedicare.com/web/jeb/fees-news/fee-schedules/mpfs

 

[JenniferB7]

You will want to check the policies for your local Medicare contractor, which can locate here: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html#MapsandLists

It is also helpful to bookmark the appropriate page(s) on the Medicare website. (https://www.cms.gov/Medicare/Medicare.html)

Keep in mind that what specific page(s) you want is dependent on the type of physician/facility you are billing for. There are links for the appropriate fee schedules and manual on each page. Publication 100-04 for Medicare Claims Processing Manual will be very helpful for billing guidelines.

For physicians (not anesthesiologists):
https://www.cms.gov/Center/Provider-Type/Physician-Center.html
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

For anesthesiologists:
https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

For Hospitals (not ASC):
https://www.cms.gov/Center/Provider-Type/Hospital-Center.html
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html

For ASCs:
https://www.cms.gov/Center/Provider-Type/Ambulatory-Surgical-Centers-ASC-Center.html
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html

Hope that helps,

Jennifer M. Connell, CPC, CPCO, CPC-P, CPB, CPMA, CPPM, CPC-I, CENTC