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

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

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

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