Annotated List of Categories for All Provider Types and People with Medicare :: Site Tutorial :: Empire Medicare Services

Content Categories

Annotated List of all Categories. Each bolded category listed below typically refers to a category page that contains more specific information and links.

Scroll down or click on a link:

Part A: NY, CT, DE, MA
Part B: New Jersey
Part B: New York
People with Medicare (Beneficiaries)

PRINTABLE lists (opens in new window):

Part A: NY, CT, DE, MA

BILLING / PAYMENT
Find information related to the electronic billing of Medicare Part A claims
1. Electronic Commerce. Institutional Electronic Data Interchange (IEDI) provides services for providers/submitters to fully automate the transfer of data between themselves and Empire Medicare Services
2. Fee Schedules. Searchable fee schedules
3. Frequently Asked Questions.
4. MDS Calendar. An interactive tool to assist a Skilled Nursing Facility with assessment periods and the associated modifier that would be billed to Medicare
5. New Provider Page. References and tools to assist someone who is new to EMS, including training materials, a Web site tour, and the education calendar
6. Publications
  - CMS Publications.External Link Manuals, forms, etc.
  - Medicare News Update (CT, DE, MA, NY). Part A provider (intermediary) newsletter
  - Medlearn Matters. Information for Medicare Providers External Link National articles that help providers understand new and changed Medicare policy
  - Part A News. Stay informed of Medicare news
  - Provider Training Tools. Access training guides, cheat sheets, job aids, reference lists, and more!
7. Self-Administered Drug Exclusion Directive.
8. SNF Help. SNF HCPCS Help File.
9. UPIN Registry (National Heritage Insurance Company). Searchable UPIN Registry database
CMS LINKS
Direct links to helpful information from the Centers for Medicare & Medicaid Services (CMS)
1. CMS Forms. A complete listing of all CMS online forms that are available
2. CMS Job Aids. Information tools to assist Customer Service Representatives (CSRs) to answer questions
3. CMS Pricer. Link to PC Pricers developed by CMS to calculate PPS payments, including IPPS, SNF, HH, IRF, and LTCH
4. CMS Provider Page. A one-stop resource focused on the informational needs and interests of Medicare providers
5. CMS Publications. Manuals, forms, etc.
6. CMS Quarterly Provider Update. A source for national Medicare provider information
7. Frequently Asked Questions.
8. HMO Listing. Get the name, address, and telephone number of a Medicare HMO
9. Medlearn Matters. Information for Medicare Providers External Link - National articles that help providers understand new and changed Medicare policy
10. Medicare Contractor Provider Satisfaction Survey (MCPSS).
11. Medicare Fee-for-Service Provider/Supplier Enrollment Information. CMS Provider Enrollment page
12. Medicare Program Manuals. CMS manuals page
13. Medicare Program Transmittal. A communication of new or changed policies and/or procedures that are being incorporated into a specific CMS program manual
14. National Correct Coding Initiative Edits. An NCCI resource
15. Payable Codes in an Ambulatory Surgical Center (ASC). Downloadable ASC Public Use files on the CMS Web site
16. Payment Systems. Payment systems including Medicare Physician Fee Schedule and SNF PPS rates
17. UB-92 Form, Information, and Specifications.
CONTACTS
Contact information for content- and/or business function-specific categories
1. A & R Contacts.
2. Beneficiary Inquiries. Beneficiary policy and billing questions
3. CERT.
4. Holiday Schedule. Holidays observed by Empire Medicare Services for the calendar year
5. NGS EDI Help Desk.
6. IVANS Help Desk. IVANS specific questions only
7. Provider Inquiries. Provider policy and billing questions
8. Provider IVR Instructions. Interactive Voice Response user guide, tips, hints, and hours of operation
COST REPORTING / AUDIT & REIMBURSEMENT
Information regarding cost reporting, interim rate setting, and Provider Statistical & Reimbursement (PS & R) report activities
1. Ambulatory Payment Classification (APC) Coinsurance Election Form Instructions. This is the form used to elect reduced coinsurance amounts for OPPS services. Any changes are due to the fiscal intermediary by December 1 for the following calendar year.
  - Ambulatory Payment Classification (APC) Coinsurance Election Form
2. A & R Contacts.
3. Clarification on TOPS Payments on PS & R Reimbursement Report. Explains the difference between the TOPS payments reported on the 15-month PS & R, which is posted to the Web site annually, and the PS & R sent to providers with settlements that are issued
4. CMS PRICER Prospective Payment System. Link to PC Pricers developed by CMS to calculate PPS payments, including IPPS, SNF, HH, IRF, and LTCH
5. Cost Report Case Study Booklets - Introduction. Case Study Workshop Booklets prepared by Blue Cross Association for both the hospital and skilled nursing facility cost reports
  - Form CMS 2540-96 ; T-11 (Skilled Nursing)
  - Form CMS 2552-96 ; T-10 (Hospital)
6. Electronic Mailing List (ListServ). Sign up here to receive important A & R updates via email!
7. Fiscal Year 2005 Graduate Medical Education Review. Microsoft Excel ^TM files to be completed by teaching providers to provide budgeted graduate medical education data needed for annual rate reviews
8. Holiday Schedule.
9. Intern and Resident Information System (IRIS) Edit Program. Download the CMS IRIS edit program and the subsequent update to the program. This program should be used by all teaching providers prior to filing their IRIS diskettes with Empire Medicare Services.
10. Medicare Wage Index Occupational Mix Survey. Information for providers submitting Occupational Mix data
  - Excel Hospital Reporting Form
  - Occupational Mix Survey and Instructions
  - Timetable
  - Wage Index Fact Sheet
11. Payment Calculation FY 2005. Microsoft Excel ^TM file to calculate and price inpatient hospital PPS claims for your facility
12. Periodic Interim Payment (PIP) Schedule: View the biweekly PIP and Pass Thru calendar
  - 2005
  - 2004
13. Provider Statistical & Reimbursement Crosswalk to the Cost Report. This form is designed to assist providers in preparing the CMS-339 to be filed with the Medicare cost report.
14. Provider Statistical & Reimbursement (PS & R) Summary Reports. Login screen for downloading PS & R reports as PDF files.
15. Request for Provider Statistical & Reimbursement (PS & R Data). Link to form MC4383, which is required for all PS & R data requests
16. Template for Electronic Filing of Bad Debt Listings. This template was designed to encourage consistency in providers filing their Medicare Bad Debt listings.
17. Tracking and Reporting Procedures for Unsolicited/Voluntary Refund Checks From Providers/Suppliers - Interim Instructions.
18. Wage Index . Special Exhibit C created by Empire Medicare Services to submit Wage Index documentation. Forms should be submitted with the provider’s cost report or to the designated wage index email address.
  - FY 2006 Hospital Wage Index Development Timetable
  - Wage Index Package (Exhibit C). In PDF or Zip. Print out the forms and then mail the hardcopy to us.
COVERAGE / POLICIES
Local and National Coverage Determinations (policies) and related information/regulations
1. CMS Medicare Coverage Database. National Coverage Database that includes local and national policies and related information
2. Local Coverage Determinations. Medical policies for Empire Medicare Services' providers
ENROLLMENT / PARTICIPATION / CERTIFICATION
Information and forms for providers who want to enroll in the Medicare program
1. Medicare Fee-for-Service Provider/Supplier Enrollment Information. CMS Provider Enrollment page
2. Provider/Supplier Enrollment. Instructions on enrolling and contact information
FORMS
A source of available forms, including CMS forms
1. 2005 MPFS CD-ROM Request Form.
2. 2005 MPFS Hardcopy Request Form.
3. Ambulatory Payment Classification (APC) Coinsurance Election Form. This is the form used to elect reduced coinsurance amounts for OPPS services. Any changes are due to the fiscal intermediary by December 1 for the following calendar year
4. CMS Forms. A complete listing of all CMS online forms
5. Credit Balance form.
6. Electronic Data Interchange (EDI) Enrollment.
7. Electronic Funds Transfer.
8. Electronic Remittance Request.
9. ESRD Beneficiary Selection Form (CMS-382). Dialysis selection form for home patients
10. Excel Hospital Reporting Form. For providers submitting Occupational Mix data
11. Form CMS 2540-96 ; T-11 (Skilled Nursing).
12. Form CMS 2552-96 ; T-10 (Hospital).
13. Health Care Provider/Supplier Application (CMS-855A).
14. Institutional Connectivity Request.
15. IVANS CSA DIALUP.
16. IVANS CSA LEASED LINE.
17. Local Coverage Determination (LCD) Reconsideration Form. LCDs which have been issued in final form by the fiscal intermediary (FI) may be considered for reconsideration, when new evidence is presented to the FI by interested parties within their jurisdiction
18. Medicare Reconsideration Request Form (CMS-20033).
19. Medicare Redetermination Request Form (CMS-20027).
20. Omnipro Logon Form.
21. PC-ACE/ PC Print/PAYMENT FORM.
22. PC-ACE/PC Print Software Order.
23. Provider Statistical & Reimbursement Crosswalk to the Cost Report. This form is designed to assist providers in preparing the CMS-339 to be filed with the Medicare Cost Report
24. Request for Medicare Forms (GEN1). Order hardcopy forms such as the CMS-2649, CMS-1964, or CMS-382
25. Request for Provider Statistical & Reimbursement (PS & R Data). Link to form MC4383, which is required for all PS & R data request
26. UB-92 Form, Information, and Specifications. CMS link to information on the paper claim forms
27. Wage Index Forms (Package). Forms should be submitted with the provider’s cost report or to the designated wage index email address
HOW TO STAY INFORMED
Resource information for a variety of Medicare and associated health care issues
1. Advisory Group Index. Provider Communications Advisory Group members list and minutes
2. Agency for Healthcare Research and Quality.
3. American Medical Association. (On-Line Catalog)
4. CMS Quarterly Provider Update. Non-regulatory changes to the Medicare program
5. Columbia University Health Pages.
6. Federal Register.
7. HHS Office of Inspector General.
8. Links to Other Contractors’ Web Sites.
9. PC-ACE/Pro32 Bulletins. Quarterly release bulletins for free billing software
10. Today's Health News from Reuters.
11. White House Information.
INITIATIVES
Information on activities and events related to health care and prevention
1. Colorectal Cancer Awareness.
2. Medicare Prescription Drug Information for Providers. Information for health care providers on this MMA mandate
3. National Provider Identifier . Apply online for your National Provider Identifier (NPI)
MEDICAL REVIEW / PROGRAM INTEGRITY
Information on Medicare fraud and protecting the Medicare Trust Funds
1. Fraud and Abuse. Tips for recognizing and preventing Medicare fraud and abuse
2. Medicare Program Integrity Manual. CMS Internet-Only Manual
MEDICARE CODING
Provides information on Medicare claims coding and external links to additional coding resources
1. ICD-9-CM Codes
  - Search by criteria exclusions on www.eicd.com
  - Search by keyword on www.e-mds.com
  - Search on www.eicd.com
2. National Correct Coding Initiative Edits. Link to www.cms.hhs.gov, an NCCI resource
3. Payable Codes in an Ambulatory Surgical Center (ASC). Downloadable ASC Public Use files on the CMS Web site
4. Remittance Advice. Information on hardcopy and electronic remittance advice notices
5. Washington Publishing Company (ANSI Codes). HIPAA-related code lists, including Claim Adjustment Reason, Remittance Remark, Denial, and Rejection codes
MEDICARE SECONDARY PAYER
Resource for providers with patients covered by more than one insurer
1. Coordination of Benefits (COB) Information. COB Provider Fact Sheets
2. Medicare Coordination of Benefits Contractor. Trading partners participating in EMS crossover program
3. Sulzer Orthopedics Settlement. Information for attorneys regarding liability cases involving certain Sulzer inter-op acetabular shells for hip implants
PROVIDER EDUCATION & TRAINING
Access training tools and live training schedule
1. CMS Free Medicare Training. These programs supplement provider education conducted by EMS
2. Frequently Asked Questions. Find answers here!
3. Live Part A Provider Training. Access schedule and register for training sessions
4. New Provider Page. (see billing and payment for details)
5. Provider Training Tools. Access training guides, cheat sheets, job aids, reference lists, and more!
6. Seminars/Training Calendar.
7. Web-Based Training. Training modules administered via our Web site
REGULATIONS & GUIDELINES
Informative resources relating to Medicare
1. CMS Quarterly Provider Update. A source on the CMS Web site for national Medicare provider information
2. Federal Register. The official daily publication for rules, proposed rules, and notices of federal agencies and organizations, as well as executive orders and other presidential documents
3. Health & Human Services (HHS) Data Council Web Site. Coordinates all health and human services data collection and analysis activities of the Department of Health and Human Services
4. Medicare Program Manuals. CMS manuals page
5. Medicare Program Transmittals. A communication of new or changed policies and/or procedures that are being incorporated into a specific CMS program manual
6. National Committee on Vital Health Statistics (NCVHS) Web Site. The public advisory body to the Secretary of Health and Human Services

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Part B: New Jersey

BILLING / PAYMENT
Items to create ease in billing, bookkeeping, and filing of Medicare claims, and reference materials designed to assist in filing Medicare claims
1. Alphabetic List of Place of Service Codes. Place of service codes and their definitions
2. Appeals - Helpful Hints. Instructions, forms, and helpful hints for doing redetermination and appeal requests
3. CMS-1500 Claim Form Information. How to complete a correct 1500 claim form
4. Electronic Commerce. Information on how to bill claims electronically, how to obtain free software, common claim rejections, vendor information, and much more
5. Fee Schedules. Fees for participating and non-participating providers, plus limiting charge fees
6. Health Professional Shortage Areas (HPSA). Information about the quarterly bonus
7. How to Refund Medicare. How to properly send monies back to Medicare
8. Medigap Insurer ID Listing.
9. Modifiers. Modifiers, CPT modifiers, HCPCS modifiers, and ambulance origin and destination modifiers
10. Self-Administered Drug Exclusion Directive. Listing of self-administered drugs
11. UPIN Registry (National Heritage Insurance Company). Link to NHIC to look up providers' UPINs
12. Valid Medicare Card and Suffixes.
CMS LINKS
Easy access to links on the CMS Web site
1. Centers for Medicare & Medicaid Services Homepage.
2. CMS Forms. SSA forms, HHS forms, standard CMS forms, and optional CMS forms
3. CMS Job Aids.
4. CMS Provider Page. Medicare program information for specific provider/practitioner types
5. CMS Publications.
6. CMS Quarterly Provider Update. Quarterly list of all non-regulatory changes to Medicare, including program memoranda, manual changes, and any other instructions that could affect providers
7. CMS Supplier Page. Medicare program information for suppliers
8. Frequently Asked Questions. CMS’s FAQs
9. Medicare Contractor Provider Satisfaction Survey (MCPSS) .
10. Medicare Fee-for-Service Provider/Supplier Enrollment Information.
11. Medicare Program Manuals. CMS manuals of programs, policies, and procedures
12. Medicare Program Transmittal. New or changed policies/procedures ready to be incorporated into the CMS program manuals
13. Medlearn Matters. Information for Medicare Providers
14. National Correct Coding Initiative Edits.
15. National Coverage Determinations (NCD). A link to NCDs on the CMS Web site
16. Payable Codes in an Ambulatory Surgical Center (ASC).
CODING
Procedure code help, links to ICD-9-CM codes, and definitions of action/remark codes found on your remittance
1. Action/Remark Codes. HIPAA related codes lists, taxonomy codes, claim status codes and more
2. Assistant Surgery Codes for 2005.
3. ESRD Related Services - Coding Changes 2005.
4. ESRD Related Services - Coding Change 2004.
5. Evaluation and Management (E & M) Guidelines. (Link to CMS) Documentation guidelines for E &M codes
6. Evaluation & Management Update. Tips on billing E & M codes to reduce CERT errors
7. National Correct Coding Initiative Edits.
8. Payable Codes in an Ambulatory Surgical Center (ASC).
9. Remittance Advice.
10. Search for ICD-9-CM Codes
  - By criteria exclusions
  - By keyword
  - EICD.com
11. Washington Publishing Company (ANSI Codes). HIPAA related code lists, taxonomy codes, claim status codes and more
CONTACTS
Options for contacting Empire Medicare Services and related entities
1. Beneficiary Inquiries.
2. Contacting the COBC. Coordination of Benefits contact information
3. Eastern Benefit Integrity Support Center. Contacting the fraud contractor
4. Electronic Services.
5. Holiday Schedule. Dates that Empire Medicare Services will be closed for business
6. Interactive Voice Recognition System (IVR). Phone number and instructions for using the natural language IVR
7. Provider Enrollment.
8. Provider Inquiries.
9. Provider Telephone Appeals.
COVERAGE / POLICIES
Local and National Coverage Determinations (policies) and related information/regulations
1. CMS Medicare Coverage Database. National Coverage Database on the CMS Web site that includes local and national policies and related information
2. Local Coverage Determinations. Empire Medicare Services' medical policies
3. National Coverage Determinations (NCD). A link to NCDs on the CMS Web site
EDUCATION & TRAINING
Register for seminars, order reference guides, view Medicare News Briefs and Medlearn Matters materials
1. Ask the Contractor Meeting minutes.
2. CMS Publications. Internet-Only Manuals (IOM) and other publications
3. Order Medicare Part B New Jersey Reference Guides Online. Can't attend a seminar?
4. Medicare News Brief - New Jersey. Part B physician/supplier (carrier) newsletter
5. Medicare Part B New Jersey Seminars. Training schedule and descriptions for Part B NJ provider seminars
6. Medlearn Matters. Information for Medicare Providers
7. Medicare Offers Free National Education And Training Program. Free self-paced courses that are available 24/7
8. News. What's new in Medicare (includes policy updates, coding changes, etc.)
9. Provider Communication Advisory Group (PCOM) Meeting. Meeting minutes
10. Seminars / Training Calendar.
11. Seminars, Workshops or Conferences. not Endorsed by or Associated with Empire Medicare Services
ENROLLMENT / PARTICIPATION / CERTIFICATION
Information and forms for providers who want to enroll in the Medicare program
1. 855 Provider/Supplier Enrollment Form Instructions.
2. 855B Organizations and Groups.
3. 855I Individual Providers.
4. 855R Reassignment of Benefits.
5. Archive. Previously published Provider Enrollment information
6. Detailed Group Instructions. Lists required sections of the 855B form for group providers
7. Detailed Individual Instructions. Lists required sections of the 855I and 855B for individual providers
8. Electronic Medicare Provider/Supplier Enrollment Forms. How to access and submit Medicare enrollment forms
9. Eligible Medicare Specialties. Alphabetical listing of specialties eligible for Medicare enrollment
10. Form Usage. Explains which forms to use for each situation
11. Important General Information. Helpful phone numbers, Web sites, and provider enrollment tips
12. Links to External Web Sites
  - CMS Provider Enrollment Web Site. Find provider enrollment forms and information
  - OIG Exclusion List
  - Information and Education Resources for Medicare Providers, Suppliers, and Physicians
13. Mass Deactivation. What to do if you are deactivated for inactivity
14. Private Contracting. Opting out of Medicare
15. Questions and Answers. Commonly asked enrollment question answered
16. Terms. Glossary and acronymns
17. What’s New.
18. Who to Contact.
FORMS
Enrollment applications, CMS-1500 claim form information, EFT application, and ABN samples
1. 1490 Denial Form.
2. Additional CMS Forms.
3. Advance Beneficiary Notice and DMEPOS Refund Requirements.
4. CMS Enrollment Applications. CMS 855I, 855B, 855R forms used to enroll as a Medicare provider or to make changes to an existing number
5. CMS-1500 Claim Form Information. CMS-1500 claim form completion, modifiers, place of service codes
6. Medicare News Brief Subscription Form.
7. Medicare Part B Claim Inquiry or Appeal Request. How to submit a redetermination request
8. Order Medicare Part B New Jersey Reference Guides Online. Can't attend a seminar?
9. Unsolicited/Voluntary Overpayment Refund Form.
HOW TO STAY INFORMED
Information about changes and updates to the Medicare program for medical professionals
1. Agency for Healthcare Research and Quality.
2. American Medical Association. (On-Line Catalog) How to order great medical literature
3. Columbia University Health Pages.
4. CMS Open Door Forums.
5. CMS Quarterly Provider Update. Quarterly list of all non-regulatory changes to Medicare, including program memoranda, manual changes, and any other instructions that could affect providers
6. Frequently Asked Questions. (Part A, Part B NJ, Part B NY)
7. HHS Office of Inspector General.
8. Links to Other Contractors’ Web Sites.
9. Reference Material.
10. Today's Health News from Reuters.
11. White House Information.
INITIATIVES
Information on activities and events related to health care and prevention
1. Colorectal Cancer Awareness.
2. Medicare Prescription Drug Information for Providers. Information for health care providers on this MMA mandate
3. National Provider Identifier. Apply online for your National Provider Identifier (NPI)
MEDICAL REVIEW / PROGRAM INTEGRITY
Information on CERT, the LCD reconsideration process, and open meetings
1. Comparative Distribution Report. How do you compare with other providers billing for CPT codes?
2. Comprehensive Error Rate Testing (CERT). Information regarding the national error rate for Medicare claims
3. Fraud and Abuse. Ways to safeguard the Medicare Trust Fund
4. Local Coverage Determinations (LCD) Reconsideration Process. Guidelines for reconsideration process of final LCDs
5. Local Provider Education and Training.
6. Open Meetings. Open meeting to discuss draft Local Coverage Determinations
7. What Is the Medical Review Department?. An overview of the role of the Medical Review Department
8. What’s New in Medical Review. Information on significant Medical Review findings and their impacts on providers
MEDICARE SECONDARY PAYER
Coordination of Benefits information for situations where Medicare is not the primary payer
1. Coordination of Benefits (COB). Listing of COB trading partners
2. Information for Attorneys Regarding Liability Cases Involving Certain Recalled Sulzer Inter-Op Acetabular Shells for Hip Implants.
3. Medicare Coordination of Benefits Contractor. COB Contractor Fact Sheet and contact information
REGULATIONS & GUIDELINES
Links to program manuals, transmittals, and CMS Quarterly Provider Updates
1. CMS Quarterly Provider Update. A source on the CMS Web site for national Medicare provider information
2. Federal Register. Official daily publications for rules, proposed rules, and notices of federal agencies and organizations published by the Office of the Federal Register
3. Health & Human Services (HHS) Data Council Web Site. Coordinates all Health and Human Services data collection and analysis activities
4. Medicare Program Manuals. Includes the Internet-Only Manual (IOM) on the CMS Web site
5. Medicare Program Transmittals. Used to communicate new or changed policies and/or procedures being incorporated into specific CMS program manuals
6. National Committee on Vital Health Statistics (NCVHS) Web Site. The public advisory body to the Secretary of Health and Human Services
7. Physician’s Role in Certifying and Planning Care for Home Health and Partial Hospitalization Programs.

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Part B: New York

BILLING / PAYMENT
Items to create ease in billing, bookkeeping, and filing of Medicare claims, and reference materials designed to assist in filing Medicare claims
1. Alphabetic List of Place of Service Codes. Place of service codes and their definitions
2. Appeals - Helpful Hints. Instructions, forms, and helpful hints for doing redetermination and appeal requests
3. CMS-1500 Claim Form Information. How to complete a correct 1500 claim form
4. Fee Schedules. Fees for participating and non-participating providers, plus limiting charge fees
5. Electronic Commerce. Information on how to bill claims electronically, how to obtain free software, common claim rejections, vendor information, and much more
6. Health Professional Shortage Areas (HPSA). Information about the quarterly bonus
7. How to Refund Medicare. How to properly send monies back to Medicare
8. Medigap Insurer ID Listing.
9. Modifiers. Modifiers, CPT modifiers, HCPCS modifiers, and ambulance origin and destination modifiers
10. Self-Administered Drug Exclusion Directive. Listing of self-administered drugs
11. UPIN Registry (National Heritage Insurance Company). Link to NHIC to look up providers' UPINs
12. Valid Medicare Card and Suffixes.
CMS LINKS
Easy access to links on the CMS Web site
1. Centers for Medicare & Medicaid Services Homepage.
2. CMS Forms. SSA forms, HHS forms, standard CMS forms, and optional CMS forms
3. CMS Job Aids.
4. CMS Provider Page. Medicare program information for specific provider/practitioner types
5. CMS Publications.
6. CMS Quarterly Provider Update. Quarterly list of all non-regulatory changes to Medicare, including program memoranda, manual changes, and any other instructions that could affect providers
7. CMS Supplier Page. Medicare program information for suppliers
8. Frequently Asked Questions. CMS’s FAQs
9. Medicare Contractor Provider Satisfaction Survey (MCPSS).
10. Medicare Fee-for-Service Provider/Supplier Enrollment Information.
11. Medicare Program Manuals. CMS manuals of programs, policies, and procedures
12. Medicare Program Transmittal. New or changed policies/procedures ready to be incorporated into the CMS program manuals
13. Medlearn Matters. Information for Medicare Providers
14. National Correct Coding Initiative Edits.
15. National Coverage Determinations (NCD). A link to NCDs on the CMS Web site
16. Payable Codes in an Ambulatory Surgical Center (ASC).
CODING
Procedure code help, links to ICD-9-CM codes, and definitions of action/remark codes found on your remittance
1. Action/Remark Codes . HIPAA related codes lists, taxonomy codes, claim status codes and more
2. Assistant Surgery Codes for 2005.
3. ESRD Related Services - Coding Changes 2005.
4. ESRD Related Services - Coding Change 2004.
5. Evaluation and Management (E & M) Guidelines. Documentation guidelines for E & M codes
6. Evaluation & Management Update. Tips on billing E & M codes to reduce CERT errors
7. National Correct Coding Initiative Edits.
8. Payable Codes in an Ambulatory Surgical Center (ASC).
9. Remittance Advice.
10. Search for ICD-9-CM Codes
  - By criteria exclusions
  - By keyword
  - EICD.com
11. Washington Publishing Company (ANSI Codes) . HIPAA related code lists, taxonomy codes, claim status codes and more
CONTACTS
Options for contacting Empire Medicare Services and related entities
1. Beneficiary Inquiries.
2. Contacting the COBC. Coordination of Benefits contact information
3. Eastern Benefit Integrity Support Center. Contacting the fraud contractor
4. Electronic Services.
5. Holiday Schedule. Dates that Empire Medicare Services will be closed for business
6. Interactive Voice Recognition System (IVR). Phone number and instructions for using the natural language IVR
7. Provider Enrollment.
8. Provider Inquiries.
9. Provider Telephone Appeals.
COVERAGE / POLICIES
Local and National Coverage Determinations (policies) and related information/regulations
1. CMS Medicare Coverage Database. National Coverage Database on the CMS Web site that includes local and national policies and related information
2. Local Coverage Determinations. Empire Medicare Services’ medical policies
3. National Coverage Determinations (NCD). A link to NCDs on the CMS Web site
EDUCATION & TRAINING
Register for seminars, order reference guides, view Medicare News Briefs and Medlearn Matters materials
1. Ask the Contractor. Meeting minutes
2. CMS Publications. Internet-Only Manuals (IOM) and other publications
3. Medicare News Brief - New York. Part B physician/supplier (carrier) newsletter
4. Medicare Offers Free National Education And Training Program. Free self-paced courses that are available 24/7
5. Medicare Part B New York Seminars. Training schedule and descriptions for Part B NJ provider seminars
6. Medlearn Matters. Information for Medicare Providers
7. News. What’s new in Medicare (includes policy updates, coding changes, etc.)
8. Order Medicare Part B New York Reference Guides Online. Can’t attend a seminar?
9. Provider Communication Advisory Group (PCOM) Meeting. Meeting minutes
10. Seminars / Training Calendar.
11. Seminars, Workshops or Conferences. not Endorsed by or Associated with Empire Medicare Services
ENROLLMENT / PARTICIPATION / CERTIFICATION
Information and forms for providers who want to enroll in the Medicare program
1. 855 Provider/Supplier Enrollment Form Instructions.
  - 855B Organizations and Groups/Detailed Group Instructions
  - 855I Individual Providers/Detailed Individual Instructions
  - 855R Reassignment of Benefits
  - What Forms to Use. Explains which forms to use for each situation
2. General Information.
  - Eligible Medicare Specialties. Listing of specialties eligible for Medicare enrollment
  - How to Enroll if Your Provider Number Has Been Deactivated. What to do if you are deactivated for inactivity
  - Private Contracting. Opting out of Medicare
  - Questions and Answers. Commonly asked enrollment questions answered
  - Terms. Glossary and acronyms
  - Who to Contact
3. Links to External Web Sites
  - CMS Provider Enrollment Web Site. Find provider enrollment forms and information
  - Information and Education Resources for Medicare Providers, Suppliers, and Physicians
  - OIG Exclusion List
FORMS
Enrollment applications, CMS-1500 claim form information, EFT application, and ABN samples
1. 1490 Denial Form.
2. Additional CMS Forms.
3. Advance Beneficiary Notice and DMEPOS Refund Requirements.
4. CMS Enrollment Applications. CMS 855I, 855B, 855R forms used to enroll as a Medicare provider or to make changes to an existing number
5. CMS-1500 Claim Form Information. CMS-1500 claim form completion, modifiers, place of service codes
6. Electronic Funds Transfer Application. Save a tree...sign up for EFT!
7. Electronic Remittance Notice. Complete this form to receive your X12 835 remittance electronically
8. Free Electronic Billing Software (PC-Ace Pro32).
9. Medicare News Brief Subscription Form.
10. Medicare Part B Claim Inquiry or Appeal Request. How to submit a redetermination request
11. Order Medicare Part B New York Reference Guides Online. Can't attend a seminar?
12. Unsolicited/Voluntary Overpayment Refund Form.
HOW TO STAY INFORMED
Information about changes and updates to the Medicare program for medical professionals
1. Agency for Healthcare Research and Quality.
2. American Medical Association . (On-Line Catalog) How to order great medical literature
3. Columbia University Health Pages.
4. CMS Open Door Forums.
5. CMS Quarterly Provider Update. Quarterly list of all non-regulatory changes to Medicare, including program memoranda, manual changes, and any other instructions that could affect providers
6. Frequently Asked Questions. Part A, Part B NJ, Part B NY
7. HHS Office of Inspector General.
8. Links to Other Contractors’ Web Sites.
9. Reference Material.
10. Today's Health News from Reuters.
11. White House Information.
INITIATIVES
Information on activities and events related to health care and prevention
1. Colorectal Cancer Awareness.
2. Medicare Prescription Drug Information for Providers. Information for health care providers on this MMA mandate
3. National Provider Identifier. Apply online for your National Provider Identifier (NPI)
MEDICAL REVIEW / PROGRAM INTEGRITY
Information on CERT, the LCD reconsideration process, and open meetings
1. Comparative Distribution Report . How do you compare with other providers billing for CPT codes?
2. Fraud and Abuse. Ways to safeguard the Medicare Trust Fund
3. Local Coverage Determinations (LCD) Reconsideration Process. Guidelines for reconsideration process of final LCDs
4. Local Provider Education and Training.
5. Medical Review.
6. Open Meetings. Open meeting to discuss draft Local Coverage Determinations
7. What’s New in Medical Review?. Information on significant Medical Review findings and their impacts on providers
MEDICARE SECONDARY PAYER
Coordination of Benefits information for situations where Medicare is not the primary payer
1. Coordination of Benefits (COB). Listing of COB trading partners
2. Information for Attorneys Regarding Liability Cases Involving Certain Recalled Sulzer Inter-Op Acetabular Shells for Hip Implants.
3. Medicare Coordination of Benefits Contractor. COB Contractor Fact Sheet and contact information
REGULATIONS & GUIDELINES
Links to program manuals, transmittals, and CMS Quarterly Provider Updates
1. CMS Quarterly Provider Update. A source on the CMS Web site for national Medicare provider information
2. Federal Register. Official daily publications for rules, proposed rules, and notices of federal agencies and organizations published by the Office of the Federal Register
3. Health & Human Services (HHS) Data Council Web Site. Coordinates all Health and Human Services data collection and analysis activities
4. Medicare Program Manuals. Includes the Internet-Only Manual (IOM) on the CMS Web site
5. Medicare Program Transmittals. Used to communicate new or changed policies and/or procedures being incorporated into specific CMS program manuals
6. National Committee on Vital Health Statistics (NCVHS) Web Site. The public advisory body to the Secretary of Health and Human Services
7. Physician’s Role in Certifying and Planning Care for Home Health and Partial Hospitalization Programs.

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People with Medicare (Beneficiaries)

EDUCATION OPPORTUNITIES
1. Education Centers for People with Medicare. To assist you with your question, Empire Medicare Services has dedicated customer service centers in various locations
2. Request a Speaker. Request a Medicare speaker for your group or organization in one of the sixteen New York State counties we serve-Bronx, Columbia, Delaware, Dutchess, Greene, Kings (Brooklyn), Nassau, New York (Manhattan), Rockland, Suffolk, Sullivan, Ulster, and Westchester
3. Seminars for People with Medicare. Empire Medicare Services offers free orientations for people with Medicare
WHAT’S NEW
1. Facts About Medicare Prescription Drug Plans. Fact sheet about Medicare prescription drugs plans
2. Introducing Medicare’s New Coverage for Prescription Drugs. Introduction to Medicare offering insurance coverage for prescription drugs through Medicare prescription drug plans
3. News for People with Medicare. This section contains the latest news for people with Medicare
MEDICARE COVERAGE AND BILLING
1. Local Coverage Determinations. Local Coverage Determination provide reasonable and necessary indications and limitations of Medicare coverage
2. Operation Restore Trust. Billions of dollars a year are lost to health care fraud. You can help stop fraud and abuse in the Medicare system!
3. Pay It Right!
  - How you can identify and report errors and concerns
  - What to do if you suspect Medicare fraud
  - What you can do to watch over Medicare spending
STAY HEALTHY
1. Colorectal Cancer Awareness. Some important facts you should know about colorectal cancer.
2. PAP Tests. A Pap test finds problems that can be treated before they turn into cancer. A Pap test can also find cancer early. If cervical cancer is found early, it’s easier to cure.
3. Preventive Care.
  - What prevention is and why it is important
  - What you pay
  - Which preventive services are new
  - Which preventive services Medicare covers and how often
  - Who can get them
4. Prostate Cancer Screening: A Decision Guide for Men with Medicare.
5. Women with Medicare.
  - What is covered in the Original Medicare Plan
  - What Medicare pays
  - What you pay
STAY INFORMED
1. 800-Alley. These sites have important health information for people with Medicare
2. Electronic Mailing List . Sign up to receive important information for people with Medicare as it becomes available
3. Frequently Asked Questions.
4. How to Read Your Medicare Summary Notice. This official government booklet shows examples of what you may see on your Medicare Summary Notice, and helps you understand how to read your notice
5. Medicare Brochures. This section lists brochures that might be helpful to people with Medicare
6. Medicare Card Replacement. Link to Social Security Administration
7. Medicare Cares, a newsletter for people with Medicare. This section contains copies of the Medicare Cares newsletter that is published four times a year by Empire Medicare Services
8. Medicare’s Web Site. For information, call 1-800-MEDICARE (1-800-633-4227)
9. Test Your Medicare Knowledge. Take a quiz
PLAN CHOICES
1. Choosing a Medicare Health Plan: A Guide for People with Medicare. Use this booklet to help you decide how to get your Medicare health care
2. Does Your Doctor or Supplier Accept Assignment?. This is the official government booklet that explains:
  - How assignment works
  - What assignment is
  - Who assignment helps
3. Facts About Medicare Advantage. This fact sheet has basic information about how Medicare Advantage affects your health care choices, and has contact information for where to get your questions answered
4. Medicare Health Plan Compare. Medicare Health Plan Compare helps you obtain detailed information on Medicare’s health plan options. By ”comparison shopping,” you can find the plans that are best for you
5. Medicare Participating Physicians/Suppliers Directory (MEDPARD).
  - New Jersey
  - New York
  The Medicare Participating Physicians/Suppliers Directory (MEDPARD) is an easy-to-use directory for Medicare beneficiaries who wish to find participating physicians and suppliers in their area
6. Private Contracts Between Beneficiaries and Doctors/Practitioners.
  - New Jersey
  - New York
  This section contains a list of the names, addresses, and UPIN numbers of those doctors/practitioners who have decided to ”opt-out” of Medicare
LONG TERM CARE
1. CMS Nursing Home Compare. This Web site contains information on every Medicare and Medicaid certified nursing home in the country. You can locate nursing homes in your area and find information about compliance with Medicare and Medicaid regulations
2. Guide to Choosing a Nursing Home. This official government booklet explains
  - How to find and compare nursing homes in your area
  - Where to call for help
  - Your nursing home resident rights
EXTRA HELP PAYING FOR MEDICAL CARE
1. Help With Prescription Drug Costs. Link to Social Security Administration
2. Medicare Savings Programs. You could save up to $799 a year, and in some cases more, in Medicare expenses. Learn about programs that can put money back in your pocket

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