Physician
Medicare Physician Guide - National Association of Clinical Nurse ...
Medicare Physician Guide - National Association of Clinical Nurse ...
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TABLE OF CONTENTS<br />
CHAPTER ONE- INTRODUCTION TO THE MEDICARE PROGRAM ................ 6<br />
CENTERS FOR MEDICARE & MEDICAID SERVICES ............................................... 7<br />
THE MEDICARE PROGRAM ...................................................................................... 8<br />
Part A and Part B Enrollment Periods ...................................................................... 8<br />
Part A – Hospital Insurance ..................................................................................... 9<br />
Part B – Medical Insurance .................................................................................... 12<br />
Part C – Medicare Advantage ................................................................................ 13<br />
Part D – Prescription Drug Plan ............................................................................. 14<br />
ORGANIZATIONS THAT IMPACT THE MEDICARE PROGRAM .............................. 15<br />
CHAPTER TWO - BECOMING A MEDICARE PROVIDER OR SUPPLIER ..... 17<br />
MEDICARE PROVIDERS AND SUPPLIERS ............................................................. 18<br />
Part A Providers and Suppliers .............................................................................. 18<br />
Part B Providers and Suppliers .............................................................................. 18<br />
<strong>Physician</strong>s .............................................................................................................. 19<br />
Interns and Residents ............................................................................................ 19<br />
Teaching <strong>Physician</strong>s .............................................................................................. 20<br />
Practitioners ........................................................................................................... 20<br />
ENROLLING IN THE MEDICARE PROGRAM ........................................................... 20<br />
National Provider Identifier ..................................................................................... 20<br />
Medicare Enrollment Application ............................................................................ 21<br />
Participating and Nonparticipating Providers and Suppliers ................................... 23<br />
PRIVATE CONTRACTS WITH MEDICARE BENEFICIARIES ................................... 26<br />
PROMOTING CULTURAL COMPETENCY IN YOUR PRACTICE ............................. 27<br />
CHAPTER THREE - MEDICARE REIMBURSEMENT ...................................... 29<br />
MEDICARE CLAIMS .................................................................................................. 30<br />
Exceptions to Mandatory Filing .............................................................................. 30<br />
Electronic Claims ................................................................................................... 31<br />
Electronic Media Claims Submissions ................................................................... 31<br />
Electronic Media Claims Submission Alternatives.................................................. 31<br />
Paper Claims.......................................................................................................... 32<br />
Durable Medical Equipment, Prosthetics and Orthotics, and Parenteral and Enteral<br />
Nutrition Claims ...................................................................................................... 32<br />
DEDUCTIBLES, COINSURANCE, AND COPAYMENTS .......................................... 33<br />
COORDINATION OF BENEFITS ............................................................................... 33<br />
Medicare Secondary Payer Program ..................................................................... 33<br />
Coordination of Benefits Contractor ....................................................................... 35<br />
INCENTIVE PAYMENTS ........................................................................................... 37<br />
Health Professional Shortage Area Incentive Payment .......................................... 37<br />
<strong>Physician</strong> Quality Reporting Initiative Incentive Payment ....................................... 38<br />
Medicare <strong>Physician</strong> Guide: A Resource for Residents, Practicing <strong>Physician</strong>s and Other Health Care Professionals 3