Part A – Browse by Facility
CORF/ORF
Access these helpful resources for more information regarding Comprehensive Outpatient Rehabilitation Facilities (CORFs) and Outpatient Rehabilitation Facilities:
Resources
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 12: Comprehensive Outpatient Rehabilitation Facility (CORF) Coverage
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 5: Part B Outpatient Rehabilitation and CORF/OPT Services
- CMS Expedited Determination Notice
Articles
Critical Access Hospital
Resources
CMS Internet-Only Manuals (IOMs)
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 1: Inpatient Hospital Services Covered Under Part A
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 3: Duration of Covered Inpatient Services
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 3: Inpatient Hospital Billing
- Section 10 – General Inpatient Requirements
- Section 30 – Medicare Rural Hospital Flexibility Program and Critical Access Hospitals (CAHs)
- Section 40 – Billing Coverage and Utilization Rules for PPS and Non-PPS Hospitals
- Section 50 – Adjustment Bills
- Section 60 – Swing Bed Services
- Section 100 – Billing Instructions for Specific Situations
- Section 130 – Coordination With the Quality Improvement Organization (QIO)
- Section 200 – Electronic Health Record (EHR) Incentive Payments
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 4: Part B Hospital (Including Hospital Part B and OPPS)
- Section 250 – Special Rules for Critical Access Hospital Outpatient Billing
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 16: Laboratory Services
- Section 30.3 – Method of Payment for Clinical Laboratory Tests – Place of Service Variation
- Section 40.3 – Hospital Billing Under Part B
- Section 40.3.1 – Critical Access Hospital (CAH) Outpatient Laboratory Services
CMS Websites
- CMS Critical Access Hospitals Center
- CMS Critical Access Hospitals Certification & Compliance
- CMS Beneficiary Notices Initiative
CMS MLN Products
- MLN006400- Information for Critical Access Hospitals
- Rural Providers and Suppliers booklet
- Swing Bed Services fact sheet
Articles
ESRD
Access these helpful resources for more information regarding services provided by Renal Dialysis Facilities:
Resources
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 11, "End Stage Renal Disease (ESRD)"
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 8: Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims
- CMS website, ESRD Quality Incentive Programs
- ESRD PPS Overview
- ESRD Consolidated Billing
- ESRD Open Door Forum Mailing List Sign-Up
Articles
- Did You Know? – End Stage Renal Disease (ESRD)
- Clarification of the ESRD PPS Low Volume Adjustment
- Changes to the End Stage Renal Disease (ESRD) PRICER to Accept the New Outpatient Provider Specific File Supplemental Wage Index Fields, the Network Reduction Calculation and New Value Code for Time on Machine
- Medicare Claims Processing Manual, Chapter 8, Section 60.4
- Modifier Finder Tool
- CMS ESRD PPS webpage
- Kidney Transplants: Billing Requirements and Organ Donor Charges
- Provider-Based Attestation Statement
Federally Qualified Health Centers (FQHC)
Access these helpful resources for more information regarding services provided in Federally Qualified Health Centers:
Resources
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 13: Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 9: Rural Health Clinics/Federally Qualified Health Centers
- MLN006397- Federally Qualified Health Center
- CMS Federally Qualified Health Centers (FQHC) Center
- CMS Frequently Asked Questions on the Medicare FQHC PPS
- CMS Change Request (CR) 8743: Implementation of a Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs)
- CMS FQHC Fact Sheet: Specific Payment Codes for the Federally Qualified Health Center Prospective Payment System (FQHC PPS)
- Medicare Billing Information for Rural Providers and Suppliers
Articles
- Chronic Care Management (CCM) Services for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) - CMS MLN Matters® MM9234
- Did You Know? Federally Qualified Health Centers
- MA Supplemental Wrap-Around Payments (reason code 37098)
- MM8743 – Implementation of a Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs)
Inpatient Acute Hospital
Access these helpful resources for more information regarding services provided in inpatient acute hospitals:
Resources
CMS Internet-Only Manuals (IOMs)
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 1: Inpatient Hospital Services Covered Under Part A
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 3: Duration of Covered Inpatient Services
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 3: Inpatient Hospital Billing
CMS Websites
- CMS Beneficiary Notices Initiative
- CMS Hospital Center
- CMS Hospital Quality Initiative
- CMS Inpatient PPS PC Pricer
Articles
- A/B Rebilling: Timeline and Claim Submission Instructions
- Did You Know? – Hospital
- Inpatient Hospital Pre-Entitlement Claims
- Inpatient Only Services
- Kidney Transplants: Billing Requirements and Organ Donor Charges
- Medicare DMEPOS Improper Inpatient Payments
- Patient Discharge Status Codes and Hospital Transfer Policies
IPF
Access these helpful resources for more information regarding services provided in Inpatient Psychiatric Facilities:
Resources
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 2: Inpatient Psychiatric Hospital Services, chapter 3: Duration of Covered Inpatient Services, and chapter 4: Inpatient Psychiatric Benefit Days Reduction and Lifetime Limitation
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 3: Inpatient Hospital Billing
- CMS website, Inpatient Psychiatric Facilities Prospective Payment System
- CMS Fee-for-Service Hospital Issued Notice of Noncoverage (HINN)
- CMS Hospital Discharge Appeal Notices
Articles
IRF
Access these helpful resources from the CMS website for more information regarding services provided in Inpatient Rehabilitation Facilities:
Resources
- Did You Know? – Inpatient Rehabilitation Facilities
- Inpatient Rehabilitation Facility Classification Criteria
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 1: Inpatient Hospital Services Covered Under Part A and chapter 3: Duration of Covered Inpatient Services
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 3: Inpatient Hospital Billing
- Inpatient Rehabilitation Facilities Prospective Payment System
- IRF Quality Reporting
- Certification & Compliance for Inpatient Rehabilitation Facilities
- CMS Fee-for-Service Hospital Issued Notice of Noncoverage (HINN)
- CMS Hospital Discharge Appeal Notices
Articles
- CMS Medicare Provider Compliance Tips Educational Tool
- Inpatient Rehabilitation Facility – Patient Assessment Instrument (IRF – PAI)
- Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius
LTCH
Access these helpful resources from the CMS website for more information regarding services provided in Long Term Care Hospitals:
Resources
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 1: Inpatient Hospital Services Covered Under Part A and chapter 3: Duration of Covered Inpatient Services
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 3: Inpatient Hospital Billing
- Long Term Care Hospital Prospective Payment System
- LTCH Quality Reporting
- CMS Fee-for-Service Hospital Issued Notice of Noncoverage (HINN)
- CMS Hospital Discharge Appeal Notices
- CMS LTCH Information
OPPS/CMHC
Access these helpful resources for more information regarding services provided in hospitals on an outpatient basis and in Community Mental Health Centers:
Resources
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 6: Hospital Services Covered Under Part B
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS)
- CMS website, Hospital Outpatient PPS
- CMS website, Fee-for-Service Advance Beneficiary Notice of Noncoverage (ABN)
- CMS website, National Correct Coding Initiative Edits
- CMS website, CMHC Certification and Compliance
- Inpatient Only Services
- OPPS Addenda
Articles
- A/B Rebilling: Timeline and Claim Submission Instructions
- Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations- SE18023
- Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations – Update- SE19007
- Billing Requirements for OPPS Providers with Multiple Service Locations- SE18002
- Did You Know?- Provider Based Billing
- Hospital Dialysis Services for People With or Without ESRD - MM7762
- Improper Payments for Hospital Outpatient Dental Services
- Infusion, Injection and Hydration Services
- Intensive Outpatient Program Services
- Outpatient Hospital Laboratory Billing Guidelines
- Proper Use of Modifiers 59 & –X{EPSU}
Rural Health Clinics (RHC)
Resources
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 13: Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 9: Rural Health Clinics/Federally Qualified Health Centers
- Information for Rural Health Clinics CMS MLN Booklet
- Rural Providers & Suppliers Billing CMS MLN Booklet
- CMS Rural Health Clinics Center
- CMS RHC Preventive Services Chart
- CMS RHC Qualifying Visit List (QVL)
- Rural Health Clinics and Medicare
FAQs
Skilled Nursing Facility
Access these helpful resources for more information regarding services provided in Skilled Nursing Facilities:
Resources
CGS Patient Driven Payment Model (PDPM)
CMS Internet-Only Manuals (IOMs)
- 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 6: SNF Inpatient Part A Billing and SNF Consolidated Billing
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 7: SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule)
CMS Fact Sheets
- Jimmo v. Sebelius Settlement Agreement Program Manual Clarifications Fact Sheet
- CMS Skilled Nursing Facility Prospective Payment System Fact Sheet
- CMS Skilled Nursing Facility (SNF) Billing Reference Fact Sheet
CMS Websites
- CMS Patient Driven Payment Model
- CMS Patient Driven Payment Model (PDPM) Frequently Asked Questions
- CMS Skilled Nursing Facility Center
- CMS Beneficiary Notices Initiative (BNI)
- CMS Nursing Home Quality Initiative
- CMS Innovation Center
Articles
- Did You Know? – Skilled Nursing Facility
- New Medicare Webpage on Patient Driven Payment Model (MLN Matters SE18026)
- Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) [MLN Matters MM11152]
- Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius
- Skilled Nursing Facility: Documentation Required to Bill Speech Therapy Services