Medicare Part B Resources — General:
www.cms.hhs.gov
Center for Medicare & Medicaid Services (CMS) homepage
www.cms.hhs.gov/QuarterlyProviderUpdates/
• CMS publishes this Update at the beginning of each quarter to inform the public about the following:
• Regulations and major policies currently under development during this quarter;
• Regulations and major policies completed or cancelled;
• New/revised manual instructions.
CMS regulations establish or modify the way CMS administers its programs. CMS' regulations may impact providers or suppliers of services or the individuals enrolled or entitled to benefits under CMS programs.
www.cms.hhs.gov/TherapyServices/
This CMS website serves as a guide to direct professionals to additional resources regarding rehabilitation therapy services, coverage requirements, payment systems, and points of contact for further information.
Medicare Part B Coverage Resources:
www.cms.hhs.gov/mcd/search.asp?
National Medicare Coverage — The National Coverage information in this database is updated "real time", except the National Coverage database download, which is updated weekly. The Local Coverage information is updated on a weekly basis, usually on Wednesdays. The current database includes all National Coverage information as of the current time, and all Local Coverage changes through 09/24/2006
www.cms.hhs.gov/mcd/index_contractorsites.asp
Links to all Medicare Contractor websites
www.cms.hhs.gov/Manuals/IOM/list.asp
CMS Internet-only Manuals (IOMs) are a replica of the Agency's official record copy. They are CMS' program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use the IOMs to administer CMS programs. They are also a good source of Medicare and Medicaid information for the general public.
www.cms.hhs.gov/Transmittals/
CMS uses transmittals to communicate new or changed policies or procedures that are incorporated into the CMS Online Manual System. The cover or transmittal page summarizes and specifies the changes.
www.cms.hhs.gov/BNI/Downloads/CMS20007English.pdf
Notice of Exclusions from Medicare Benefit (NEMB) (PDF Format)
www.cms.hhs.gov/BNI/
Advanced Beneficiary Notice (ABN). Used to notify patients prior to a service being received that there may be a chance that in their situation it may not be covered/paid (PDF Format)
www.cms.hhs.gov/CompetitiveAcqforDMEPOS/04_new_quality_standards.asp
CMS has published new quality standards for suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
www.cms.hhs.gov/MLNGeninfo/
CMS' Medicare Learning Network (MLN) containes educational information for Medicare fee-for-service providers. Located in the Centers for Medicare & Medicaid Services (CMS), the Medicare Learning Network is a brand name for official CMS national provider education products designed to promote national consistency of Medicare provider information developed for CMS initiatives.
www.cms.hhs.gov/MLNMattersArticles/
The CMS MLN Matters is a series of national articles designed to inform the physician, provider, and supplier community about the latest changes to the Medicare Program.
www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=176
CMS has determined that
there is sufficient evidence to conclude that the use of infrared devices is not
reasonable and necessary for treatment of Medicare beneficiaries for diabetic
and non-diabetic peripheral sensory neuropathy, wounds and ulcers, and similar
related conditions, including symptoms such as pain arising from these
conditions. Therefore, they have issued the following National Coverage
Determination
Therapy Billing — Medicare Part B Resources:
http://www.cms.hhs.gov/TherapyServices/02_billing_scenarios.asp
This website is designed to clarify existing therapy policy and to provide guidance on current Part B billing issues relevant to physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) and to the services they provide.
www.cms.hhs.gov/transmittals/downloads/R1019CP.pdf
CMS Transmittal 1019, 08/03/06; This instruction provides additional limitations on outpatient therapy services, consistent with the provisions of the Deficit Reduction Act of 2005. Certain services are limited to certain numbers of units per day for physical therapy , occupational therapy and speech-language pathology, separately to control inappropriate billing.
Documentation Resources:
www.cms.hhs.gov/Transmittals/downloads/R63BP.pdf
CMS Transmittal 63, 12/29/06; Outpatient Therapy Cap Clarifications,
Including revisions to Medicare Benefit Policy Manual, Chapter 15, Covered
Medical and Other Health Services, Section 220.3.5
www.cms.hhs.gov/Transmittals/downloads/R60BP.pdf
CMS Transmittal 60, 11/09/06; Outpatient Therapy Cap Clarifications,
Including revisions to Medicare Benefit Policy Manual, Chapter 15, Covered
Medical and Other Health Services, Section 220.3.5
www.cms.hhs.gov/Transmittals/downloads/R52BP.pdf
CMS Transmittal 52, 06/30/06; Documentation Requirements for Therapy Services, Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, 220.3.5
www.apta.org/AM/Template.cfm?Section=Policies_and_Bylaws&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=31688
Documentation Guidelines of the American Physical Therapy Association
New for 2007! Medicare Therapy Cap Resources:
On December 29,
2006, CMS issued three new transmittals regarding the outpatient
therapy cap exceptions process for 2007 (links are below). Of significance, CMS has
eliminated the manual exceptions process so all exceptions
will be automatic. The changes to
these transmittals are denoted in red font in the published
transmittals.
www.cms.hhs.gov/Transmittals/downloads/R1106CP.pdf
CMS Transmittal 1106, 11/09/06; Therapy Cap Exceptions Process
- Clarifies and expands descriptions of the process
for therapy cap exceptions. Corrects errors on the list of conditions and
complexities for which exceptions are allowed. Announces the therapy cap amount
for calendar year 2007. As of 11/18/06, there will be no Exceptions Process for
2007 unless Congress takes action.
www.cms.hhs.gov/Transmittals/downloads/R171PI.pdf
CMS Transmittal 171, 11/09/06; Outpatient Therapy Cap Clarifications-
Clarifies contractor instructions related to therapy
cap exception process.
www.cms.hhs.gov/Transmittals/downloads/R140PI.pdf
CMS Transmittal 140, 02/15/06; Therapy Cap Exceptions Process - Medicare Program Integrity Manual Medicare Part B Resources Therapy Cap
www.cms.hhs.gov/Transmittals/downloads/R855CP.pdf
CMS Transmittal 855, 02/15/06; Therapy Cap Exceptions Process - Medicare Claims Manual
www.cms.hhs.gov/apps/media/press/release.asp?Counter=1782
CMS Fact Sheet on Therapy Cap Exceptions Process Medicare Part B Resources Therapy Cap
www.cms.hhs.gov/MLNMattersArticles/downloads/MM4364.pdf
Medlearn Matters article describing the Therapy Cap Exceptions Process
Correct Coding Initiative (CCI) Resources:
