reimbursement@wiki

Innovator's Guide to Navigating CMS

• v1.0 (August 25, 2008)

 

Medicare Literature

 

DME

Internet-Only Manuals (list or direct link)

RULES (Proposed and Final) & ACTIVITIES (e.g., Work Plan)

·        2009

·        2008

·        2007

·        2006

·        2005

·        2004

·        2003

·        2002

CONVERSION FACTORS

	2006	2007	2008
MPFS	$37.8975	$37.8975	$34.0682
OPPS	$59.511	$61.468	$63.694
IPPS	#	#	#

 

SETTINGS

• Hospital Inpatient
• • Acute Inpatient Prospective Payment System Fact Sheet
  •  HIPPS
  • Medicare Severity Diagnosis-Related Group (MS-DRG)

• Hospital Outpatient
• • Hospital Outpatient Prospective Payment System Fact Sheet
  • HOPPS
  • Ambulatory Surgical Center (ASC)
  • Inpatient List

• Physician Office
• • Medicare Physician Fee Schedule Fact Sheet
  • Competitive Acquisition Program (CAP)

• Home Health
• Long-Term Care (LTC)
  

 

TOPICS

• Bilateral Surgeries
• Claims Appeals Process
• Clinical Trial Policy (CTP) / Clinical Research Policy (CRP)
• Coding
• Compendia
• CAP (Competitive Acquisition Program)
• Compounding
• Correct Coding Initiative (CCI)
• Coverage (LCD, NCD, etc.)
• Coverage with Evidence Development
• Data Compendium
• DRG (Diagnosis-Related Group)
• Drug Coverage
• Drug Administration
• Durable Medical Equipment (DME)
• Equivalence (bio-, therapeutic, functional)
• Evidence-Based Medicine (EBM)
• Fee Schedules
• HCAHPS and Hospital Compare
• Inhalation Drug Dispensing Fee
• Injections / Infusions
• Inpatient List
• Laboratory
• Medicare Administrative Contractors (MACs)
• Medicare Evidence Development & Coverage Advisory Committee (MedCAC)
• Medicare Learning Network (MLN)
• National Correct Coding Initiatives Edits
• Part B versus Part D Drug Coverage Determinations
• Payment
• Place of Service (POS)
• Pricing
• Quality
• Status Indicators
• Surgical Discounting (see Hospital Outpatient Setting)
• Trustees Reports

 

STATISTICS

·        Research Data Assistance Center (ResDAC)

·        For statistics on inpatient services, the Fee-For-Service MedPAR statistics page would provide information on total charges, Medicare reimbursement, and days by state or DRG.

·        For statistics on physician services, the Fee-For-Service statistics page under the section Medicare Utilization for Part B provides information on allowed charges and allowed services for the Top 200 HCPCS codes.

 

HEALTH POLICY ORGANIZATIONS, SITES, RESOURCES

• MedPAC (Medicare Payment Advisory Commission)

o       2007 Data Book

o       Medicare Payment Basics

• KaiserEDU.org
• Tutorial: Medicare 101
• Alliance for Health Reform

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