Physician

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Quality Improvement Organizations http://www.cms.hhs.gov/QualityImprovementOrgs/01_Overview.asp Quarterly Provider Updates http://www.cms.hhs.gov/QuarterlyProviderUpdates Regulations & Guidance http://www.cms.hhs.gov/home/regsguidance.asp Resident Training Listserv https://list.nih.gov State Health Insurance and Assistance Programs http://www.cms.hhs.gov/Partnerships/10_SHIPS.asp Survey & Certification – General Information http://www.cms.hhs.gov/SurveyCertificationGenInfo/03_ContactInformation.asp Therapy Services http://www.cms.hhs.gov/TherapyServices OTHER ORGANIZATIONS American Medical Association Bookstore (Current Procedural Terminology and Healthcare Common Procedure Coding System publications) http://www.amapress.org (800) 621-8335 American Medical Association Current Procedural Terminology Information http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-yourpractice/coding-billing-insurance/cpt.shtml Federal Financial Institutions Examination Council (census tracts) http://www.ffiec.gov/Geocode/default.aspx National Uniform Billing Committee http://www.nubc.org/guide.html Railroad Medicare Part B Office (800) 833-4455 Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 95
United Mine Workers of America Electronic Medical Claims Submission Information (888) 865-5290 U.S. Department of Health and Human Services Administration on Aging http://www.aoa.gov U.S. Department of Health and Human Services Health Resources and Services Administration http://www.hrsa.gov U.S. Department of Health and Human Services Health Resources and Services Administration Shortage Areas by State and County http://www.hpsafind.hrsa.gov U.S. Department of Health and Human Services Office of Inspector General http://www.oig.hhs.gov U.S. Department of Health and Human Services Office of Inspector General List of Excluded Individuals/Entities http://www.oig.hhs.gov/fraud/exclusions/exclusions_list.asp U.S. Department of Health and Human Services Office of Inspector General National Hotline (800) 447-8477 U.S. Department of Health and Human Services Office of Medicare Hearings and Appeals http://www.hhs.gov/omha U.S. Department of Health and Human Services Office of Minority Health Cultural Competency Continuing Education Programs http://thinkculturalhealth.org U.S. General Services Administration Excluded Parties List System http://www.epls.gov Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 96
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Medicare Physician Guide A Resource
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ICD-9-CM Notice The International C
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MEDICARE PHYSICIAN FEE SCHEDULE ...
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CHAPTER ONE INTRODUCTION TO THE MED
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THE MEDICARE PROGRAM The Medicare P
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worker must have a specified number
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Part B - Medical Insurance Some of
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Where to Find Additional Informatio
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CMS contracts with one Quality Impr
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This chapter discusses Medicare pro
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staff or faculty appointments, part
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The following forms are often requi
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Accept the Medicare allowed amount
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Below is an illustration of the pay
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cultural background, or ability to
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This chapter provides information a
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suppliers can obtain a list of elec
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Insurer information (name, group nu
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Coordination of Benefits Contractor
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In these situations, the physician
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Where to Find Additional Informatio
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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
Page 81 and 82: 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: National Provider Identifier Standa
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 143 and 144: Content and Documentation Requireme
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System/Body Area Musculoskeletal Ex
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Neurological Examination System/Bod
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Content and Documentation Requireme
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System/Body Area Psychiatric Elemen
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System/Body Area Gastrointestinal (
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System/Body Area Skin Elements of E
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NUMBER OF DIAGNOSES OR MANAGEMENT O
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RISK OF SIGNIFICANT COMPLICATIONS,
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D. DOCUMENTATION OF AN ENCOUNTER DO
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Physician

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