Physician

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FEE-FOR-SERVICE APPEALS ................................................................................. 71 The Five Levels of Appeals .................................................................................... 72 Liability and Appeal Decisions ............................................................................... 76 Reopenings ............................................................................................................ 76 REFERENCE SECTION .................................................................................... 78 GLOSSARY ............................................................................................................... 79 ACRONYMS .............................................................................................................. 86 CONTACT INFORMATION ....................................................................................... 91 1995 DOCUMENTATION GUIDELINES FOR EVALUATION & MANAGEMENT SERVICES ................................................................................................................ 98 1997 DOCUMENTATION GUIDELINES FOR EVALUATION & MANAGEMENT SERVICES .............................................................................................................. 114 Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 5
CHAPTER ONE INTRODUCTION TO THE MEDICARE PROGRAM Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 6
Page 1 and 2: Medicare Physician Guide A Resource
Page 3 and 4: ICD-9-CM Notice The International C
Page 5: MEDICARE PHYSICIAN FEE SCHEDULE ...
Page 9 and 10: THE MEDICARE PROGRAM The Medicare P
Page 11 and 12: worker must have a specified number
Page 13 and 14: Part B - Medical Insurance Some of
Page 15 and 16: Where to Find Additional Informatio
Page 17 and 18: CMS contracts with one Quality Impr
Page 19 and 20: This chapter discusses Medicare pro
Page 21 and 22: staff or faculty appointments, part
Page 23 and 24: The following forms are often requi
Page 25 and 26: Accept the Medicare allowed amount
Page 27 and 28: Below is an illustration of the pay
Page 29 and 30: cultural background, or ability to
Page 31 and 32: This chapter provides information a
Page 33 and 34: suppliers can obtain a list of elec
Page 35 and 36: Insurer information (name, group nu
Page 37 and 38: Coordination of Benefits Contractor
Page 39 and 40: In these situations, the physician
Page 41 and 42: Where to Find Additional Informatio
Page 43 and 44: OTHER HEALTH INSURANCE PLANS Medica
Page 45 and 46: Part B Railroad Retirement Benefits
Page 47 and 48: This chapter discusses Medicare cov
Page 49 and 50: 2) Renal dialysis treatments Renal
Page 51 and 52: 2) Furnished by the physician or au
Page 53 and 54: Services that are considered not me
Page 55 and 56: This chapter discusses common sets
Page 57 and 58:
International Classification of Dis
Page 59 and 60:
CHAPTER SIX PROTECTING THE MEDICARE
Page 61 and 62:
codes that describe what is and is
Page 63 and 64:
Consistently using billing or reven
Page 65 and 66:
Investigations A Program Safeguard
Page 67 and 68:
Sanctioned and Reinstated Provider
Page 69 and 70:
CHAPTER SEVEN INQUIRIES, OVERPAYMEN
Page 71 and 72:
If Medicare pays more than the corr
Page 73 and 74:
It contains the name, telephone num
Page 75 and 76:
filed), the time limit will be exte
Page 77 and 78:
Liability and Appeal Decisions Liab
Page 79 and 80:
REFERENCE SECTION Medicare Physicia
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Coinsurance Under the Original Medi
Page 83 and 84:
Medically Necessary Services or sup
Page 85 and 86:
Participating Provider or Supplier
Page 87 and 88:
ACRONYMS AA ABN AEP AIC ALJ ASC CAH
Page 89 and 90:
HIC HIPAA HPSA ICD-9-CM ICD-10-CM/P
Page 91 and 92:
RRB RVU SA SEP SGR SHIP SLP SNF SSA
Page 93 and 94:
Electronic Billing & EDI Transactio
Page 95 and 96:
National Provider Identifier Standa
Page 97 and 98:
United Mine Workers of America Elec
Page 99 and 100:
1995 DOCUMENTATION GUIDELINES FOR E
Page 101 and 102:
II. DOCUMENTATION OF E/M SERVICES T
Page 103 and 104:
DG: The CC, ROS and PFSH may be lis
Page 105 and 106:
For purposes of ROS, the following
Page 107 and 108:
DG: At least one specific item from
Page 109 and 110:
C. DOCUMENTATION OF THE COMPLEXITY
Page 111 and 112:
occasion the physician who ordered
Page 113 and 114:
Table of Risk Level of Risk Present
Page 115 and 116:
1997 DOCUMENTATION GUIDELINES FOR E
Page 117 and 118:
I. INTRODUCTION WHAT IS DOCUMENTATI
Page 119 and 120:
III. DOCUMENTATION OF E/M SERVICES
Page 121 and 122:
DG: The CC, ROS and PFSH may be lis
Page 123 and 124:
REVIEW OF SYSTEMS (ROS) A ROS is an
Page 125 and 126:
DG: At least one specific item from
Page 127 and 128:
Problem Focused Examination - shoul
Page 129 and 130:
System/Body Area Respiratory Elemen
Page 131 and 132:
System/Body Area Musculoskeletal Ex
Page 133 and 134:
Cardiovascular Examination System/B
Page 135 and 136:
Ear, Nose and Throat Examination Sy
Page 137 and 138:
Content and Documentation Requireme
Page 139 and 140:
System/Body Area Elements of Examin
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
System/Body Area Musculoskeletal Ex
Page 149 and 150:
Neurological Examination System/Bod
Page 151 and 152:
Page 153 and 154:
System/Body Area Psychiatric Elemen
Page 155 and 156:
System/Body Area Gastrointestinal (
Page 157 and 158:
System/Body Area Skin Elements of E
Page 159 and 160:
NUMBER OF DIAGNOSES OR MANAGEMENT O
Page 161 and 162:
RISK OF SIGNIFICANT COMPLICATIONS,
Page 163:
D. DOCUMENTATION OF AN ENCOUNTER DO
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Physician

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