Other Useful Web Sites

Government Health Care Sites

• Centers for Medicare & Medicaid Services (CMS) - (formerly the Health Care Financing Administration) administers the Medicare and Medicaid programs, which provide health care to America's aged and indigent populations, about one in every four Americans, including nearly 18 million children and and nursing home coverage for low-income elderly. CMS also administers the new Children's Health Insurance Program through approved state plans that cover more than 2.2 million children.
  • CMS Central Provider Page - CMS wants to ensure providers and health care practitioners have quick access to accurate Medicare program information. In keeping with this goal, the provider-specific pages are a one-stop resource focused on the informational needs and interests of Medicare providers, including physicians and other practitioners.
  • CMS Competitive Acquisition Program
  • CMS Competitive Acquisition for DMEPOS
  • CMS Coordination of Benefits Agreement
  • CMS FAQs  - Link to frequently asked questions.
  • CMS Forms  - CMS is making many of its Program Forms available in Portable Document Format (PDF) for informational purposes.
  •  CMS HIPAA Website - In 1996, Congress passed into law the Health Insurance Portability and Accountability Act (HIPAA). This Act is comprised of two major legislative actions: Health Insurance Reform and Administrative Simplification. For the health care industry to achieve the potential administrative cost savings, and administrative simplification with Electronic Data Interchange (EDI), standards have been developed and need to be implemented consistently by all organizations. This site includes General Information, Regulations and Standards, HIPAA Enforcement, Upcoming Events, Educational Materials, and other HIPAA related links.
  • CMS MREP Software - CMS presents the Medicare Remit Easy Print (MREP) software to view and print the Health Insurance Portability and Accountability Act (HIPAA) compliant 835 for professional providers and suppliers. This software, which is available for free to Medicare providers and suppliers, can be used to access and print remittance advice information, including special reports, from the HIPAA 835.
  • CMS Manuals and Transmittals - This is the CMS site for downloading CMS Manuals and CMS Transmittals.
  • CMS Medicare Supplier Page - CMS wants to ensure suppliers have quick access to accurate Medicare program information. In keeping with this goal, the supplier information specific pages are a one-stop resource focused on the informational needs and interests of Medicare suppliers.
  • CMS National Provider Identifier Standard (NPI) - This is the CMS National Provider Identifier Standard (NPI) homepage
  • CMS Press Releases - This is the CMS site for downloading CMS press releases.
  • CMS Therapy Resources: Medicare financial limits on Therapy (Therapy Caps) is a very hot topic. CMS has developed a Therapy Resources area on their web site. Therapy Resources provide information about physical therapy, occupational therapy, speech-language pathology, and audiology.
  • COB Information - The Coordination of Benefits (COB) Contractor consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries.
  • Correct Coding Initiative (CCI) - The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative to promote national correct coding methodologies and to eliminate improper coding.
  • ICD-9-CM Codes - This web page provides information related to ICD-9-CM.
  • MLN Matters  - The Centers for Medicare & Medicaid Services and your Medicare Learning Network introduces MLN Matters, an educational resource for Medicare Providers. MLN Matters is designed to inform you of important changes to the Medicare system in a user-friendly format that will accommodate your busy schedule.
  • Medicare Approved Transplant Centers - The Medicare approved transplant list can be found here.
  • Medicare Contractor Provider Satisfaction Survey (MCPSS) - The Medicare Contractor Provider Satisfaction Survey (MCPSS) is designed to garner quantifiable data on provider satisfaction with the performance of Medicare Fee-for-Service (FFS) Contractors. The MCPSS is one of the tools CMS will use to measure provider satisfaction levels, a requirement of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).
  • Medicare Learning Network - This is the CMS Medicare Learning Network. The Medicare Learning Network web site was established in response to the increased usage of the Internet as a learning resource by Medicare health care professionals.
  • Medicare Part B Drugs Average Sales Price (ASP) Information Resource
  • Medicare Physician Web Site - A physician Web page is now available on the CMS Web site. The page includes links to general information on enrollment, billing, conditions of participation, publications, education, training, data, and statistics. There are also links to specific information on the physician fee schedule, the Practicing Physicians Advisory Council (PPAC), the Physician Regulatory Issues Team (PRIT), Medicare payments, and the participating physician directory. We continue to work on improvements and will be soliciting feedback to make the page as comprehensive and as easy to navigate as possible.
  • Medicare Prescription Drug Coverage Information for Providers
  • National Plan and Provider Enumeration System (NPPES) Web Site
    The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers, as well as the adoption of standard unique identifiers for health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers.
  • Office of HIPAA Standards Listserv: The Centers for Medicare & Medicaid Services’ (CMS) Office of HIPAA Standards (OHS) has recently developed a listserv for the purpose of sharing pertinent and timely information on HIPAA administrative simplification issues with interested parties. By joining the listserv, you will receive important news and announcements about HIPAA tools and information. You will also receive the monthly CMS HIPAA Update, which highlights important new information.
  • Physician Quality Reporting Initiative - PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.
  • Physician Voluntary Reporting Program (PVRP) - As part of its overall quality improvement efforts, CMS launched the Physician Voluntary Reporting Program (PVRP) on January 1, 2006. This new program builds on Medicare’s comprehensive efforts to substantially improve the health and function of beneficiaries by preventing chronic disease complications, avoiding preventable hospitalizations, and improving the quality of care delivered. Under this voluntary reporting program, physicians who choose to participate will help capture data about the quality of care provided to Medicare beneficiaries.
  • Prescription Drug Coverage - This is The Official U.S. Government Site for People with Medication. This link will take you directly to the Part D Prescription Drug Coverage Section.
  • Provider Enrollment - The CMS Provider Enrollment site is designed to provide Medicare enrollment information for providers and suppliers of medical and health services.  This section includes information on how to enroll, application forms and instructions, contacts for all Intermediaries, Carriers, CMS Regional Offices, and State Agencies, frequently asked questions and more.
  • Quarterly Provider Update (QPU) - The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS website. Providers may elect to join a CMS electronic mailing list to be notified periodically, of additions to the QPU. The mailing lists are available at http://www.cms.hhs.gov/apps/mailinglists/. The CMS QPU Mailing List makes it easier for users to keep track of changes to the CMS Quarterly Provider Update (QPU). This service notifies subscribers via email immediately of any regulations or program instructions released during the quarter.
  • Working with Plan Formularies: Transition Supplies, Prior Authorization, Quantity Limits, Step Therapy and Exceptions
  • The recently formed Provider Communications Group within the Center for Medicare Management has developed new provider audience-based web pages for the Centers for Medicare & Medicaid Services (CMS) Web site. The following provider/ supplier pages are already developed:
    
    Ambulance Services
    Physicians
    Hospitals:
     Acute Inpatient
    - Outpatient Prospective Payment System
    - Long-Term Care Hospitals
    - Inpatient Rehabilitation Facilities
     

• Department of Health and Human Services- The United States Government's principle agency for protecting the health of all Americans
• Library of Congress - This official government website contains information on pending legislation for Medicare, etc
• The Agency for Healthcare Research Quality- AHRQ is a part of the U.S. Department of Health and Human Services. It is the lead agency responsible for research design to improve the quality and cost of health care.
• The Social Security Administration- This is the official site of the Social Security Administration. You can find information on everything from Information on Social Security Benefits to Research and Statistical Data.
• Sanctioned Docs Listing- The HHS Office of Inspector General imposes exclusions on individuals and entities based on the authority contained in Sections 1128 and 1156 of the Social Security Act. This List of Excluded Individuals/Entities is a listing of all parties excluded as of the date of publication.

Health Care Research and Reference Sites

• Remittance Advice Remark Codes and Claim Adjustment Reason Codes - Your Remittance Advice notice can be a useful tool to your office. The remittance advice can contain adjustment reason codes and remark codes that explain payment modifications made and other important information related to the claim. This site will give you a description of reason codes and remark codes used on your remittance advice notice.
• UPIN Database- A Unique Physicians Identification Number database which can be used to search for UPIN information.
• National Technical Information Service- NTIS is the CMS (formerly HCFA) authorized distributor of CCI codes.  This site includes National Correct Coding Initiative (CCI) reference tools, including the National Correct Coding Policy Manual for Part B Medicare Carriers
• American Academy of Professional Coders- AAPC provides education, certification, networking, and recognition in an effort to raise the professional standard of medical coders.

Other Medicare Intermediary and Contractor Sites

• Durable Medical Equipment Regional Carrier (DMERC) - The DMERC is responsible for processing all durable medical equipment and supply claims.
• Regional Home Health Intermediary (RHHI): This contractor is responsible for processing claims for home health care and hospice care
• Railroad Medicare - Palmetto