CMS-level Guidance
Critical Access Hospitals (CAH)
Access CMS-level guidance for Critical Access Hospitals (CAHs) through the following links:
DMEPOS Part A
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Access CMS-level guidance for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) through the following links:
- CMS 'DME Center'
- Jurisdiction List to identify the correct Medicare contractor for DMEPOS claims
- CMS DMEPOS Competitive Bidding Program website
Other CMS Guidance:
- Durable Medical Equipment: (1.14 MB) CMS Medicare Benefit Policy Manual, Chapter 15, Section 110
- DMEPOS: CMS Medicare Claims Processing Manual, Chapter 20
General
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Access the articles listed below for more information about topics and programs that are of general interest to Medicare providers. You may also find the following additional resources helpful:
- CMS Medicare home page
- Online enrollment for Medicare Providers: Internet-based PECOS
Hospitals
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Access CMS-level guidance for hospitals through the following links:
- CMS Hospitals Web page
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 25: 'Completing and Processing the Form CMS-1450 Data Set'
ICD-10
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Important ICD-10 resource:
Long Term Care Hospitals (LTCH)
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Access CMS-level guidance for Long Term Care Hospitals (LTCHs) through the following links:
- CMS LTCH PPS information
- Sign up for the CMS LTCH PPS e-mail list
ORF-CORF-OPT
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Access CMS-level guidance regarding services provided in comprehensive outpatient rehabilitation facilities (CORFs) and outpatient rehabilitation facilities (ORFs), as well as guidance regarding physical therapy services, through the following links:
- Specific payment requirements for CORF items and services: CMS Pub. 100-04, chapter 5
- MLN Matters article MM6005: 'Comprehensive Outpatient Rehabilitation Facility Manual'
- CMS home page for therapy services
- Proposed changes in therapy payments: Developing Outpatient Therapy Payment Alternatives (DOTPA) [No longer available]
- 2010 Therapy Cap information
Recovery Audit Contractor
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Recovery audit contractors (RACs) are responsible for identifying improper
payments made on claims of health care services provided to Medicare beneficiaries.
The RAC program was established by Section 302 of the Tax Relief and Health
Care Act of 2006.
Access additional information about RACs through these resources:
Renal Dialysis Facilities (RDF)
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Access CMS-level guidance for renal dialysis facilities through the following links:
- CMS ESRD Center
- CMS Medicare Claims Policy manual (Pub. 100-04), Chapter 8: 'Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims'
- CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 32, Section 20: 'Information on submitting claims for Kidney Disease Patient Education Services'
Rural Health Clinics (RHC)
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Access CMS-level guidance for rural health clinics (RHCs) through the following links:
- CMS RHC Web page
- CMS Medicare Learning Network RHC Fact Sheet
- CMS Benefit Policy Manual (Pub. 100-02), chapter 13
- CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 9: FQHCs/RHCs
Skilled Nursing Facilities (SNF)
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Access CMS-level guidance for skilled nursing facilities (SNFs) through the following links:
- CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 8: 'Coverage of Extended Care (SNF) Services Under Hospital Insurance'
- CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 7: 'SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule'
- CMS SNF Consolidated Billing website
- Sign up for the CMS SNF e-mail list