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Medicare National Coverage Determinations Manual

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Transmittals for Chapter 1 Part 1 (Sections 10 – 80.12)   Transmittals for Chapter 1 Part 2 (Sections 90 – 160.26)   Transmittals for Chapter 1 Part 3 (Sections 170 – 190.34)   Transmittals for Chapter 1 Part 4 (Sections 200 – 310.1) Crosswalk from NCD Manual to Coverage Issues Manual (CIM) [PDF, 447KB] Crosswalk […]

OIG Work Plan 2016

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The Work Plan describes the primary objectives and provides for each review its internal identification code and the year in which OIG expects one or more reports to be issued as a result of the review. Get the PDF (80 pages)

IPPS Final Rule FY2016

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CMS has released updates to the FY2016 Final Rule published August 17, 2015. Both the FY2016 IPPS Final Rule (August 17, 2015) and the corrections (October 5, 2015) are available. Description: We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising […]

Health IT Certification 2015

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This document will be published in the Federal Register on October 16, 2015. The currently available copy is in .pdf format. This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or “2015 Edition”) and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying […]

CMS Inpatient Only List CY2015

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Procedures That Will be Paid Only as Inpatient for CY2015 This is a zip file for download. CPT® license agreement required.   CY2015 OPPS Addenda [ZIP, 2.8 MB] (The 2015 Inpatient Only List is here as Addendum E.) It is available as an Excel file or as a Text file. Effective April 1, 2015, a new […]

CMS Inpatient Only List CY2014

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Procedures That Will be Paid Only as Inpatient for CY2014 This is a zip file for download. CPT® license agreement required.   CY2014 OPPS Addenda [ZIP, 1.8 MB] (The 2014 Inpatient Only List is here as Addendum E.)

Condition Code W2

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CMS Transmittal 1203 dated March 22, 2013 MLN Matters (revised July 6, 2013) These documents provide guidance for billing Part B inpatient claims and the use of condition code W2.  

Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal

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This interim final rule with comment period specifies the process and timeline for expanding CMS’ existing Medicare Secondary Payer (MSP) Web portal to conform to section 201 of the Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act). The interim final rule specifies a timeline for developing a multifactor authentication […]

IPPS Final Rule FY2014

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According to CMS the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals is being revised.  Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable […]