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Medicare Payment and Regulations Resources
We understand the challenges of keeping current on how to appropriately bill and code for your Medicare patients. Below are a number of resources to help you ensure that you are paid appropriately and are not in violation of any Medicare policies.
The Medicare Access and CHIP Reauthorization Act of 2015 provides a more stable payment system for physicians while transitioning physicians away from a volume-based system toward one that rewards value. Learn more about the law and what physicians need to do to prepare for the changes.Learn more
Getting Started with Medicare
- Medicare Enrollment Resources
- Web-based Training (WBT) Courses: Free tools from CMS that allow doctors and their staff to learn about a broad range of Medicare related issues.
- Opting out of Medicare and/or Electing to Order and Refer Services
- Additional information on Ordering and Referring from the AMA: Ordering/Referring Fact Sheet
Additional Payment Issues under Medicare
- 2017 Medicare Proposed Physician Fee Schedule Summary
- Frequently-Asked-Questions (FAQs) Regarding the Centers for Medicare and Medicaid Services (CMS) Release of Physician Payment Data
- Physician Claims under Sequestration Rules for Medicare
- Telehealth Fact Sheet: Telehealth is reimbursed for services provided to patients in a Health Professional Shortage Area or in a county that is outside of any Metropolitan Statistical Area using real-time audio and video technology.
- Medicare Beneficiary Identifier
How to Comply with Medicare Regulations
Advance Care Planning
Chronic Care Management
- Chronic Care Management (CCM) Tool Kit: This new tool kit provides what practices need to implement the new CCM codes, including background information for clinicians and staff, a step-by-step implementation guide, and a sample patient agreement.
- Resources from CMS: CMS' Chronic Care Management Services Fact Sheet and CCM Medicare Billing FAQs
Transition Care Management Codes
Transition Care Management Codes: How to bill for the non-face-to-face care provided when patients transition from an acute care setting.
Preventive Care Visits
- "Welcome to Medicare" Exam
- Annual Wellness Visit
- IPPE and AWV FAQs
- Guide to Medicare Preventive Services Codes & Billing Information: This is an interactive PDF, in which you can click on a service at the left to view that service's information. Please note: some browsers may not display this file properly.
- CMS Provider Minute: Preventive Services: This short video explains proper billing and documentation for preventive services.
- Medicare Preventive Services: For each preventive service, this tool provides codes to use, who is covered, how often it is covered, and copay and deductible rules. (Printable version)
Home Health Face-to-Face Encounter Requirement
Care Plan Oversight Encounter Worksheet and Instructions
Care Plan Oversight Encounter Worksheet and Instructions (ACP login required)
Value Based Payment Program
Medicare Improper Payment Review
Advanced Beneficiary Notices (ABN)
Medicare Part D Resources
Physician Quality Reporting System (PQRS)
The Physician Quality Reporting System is a voluntary CMS quality program. The PQRS program encourages eligible professionals and group practices to report information on the quality of care to Medicare patients, helping to ensure that patients get the right care at the right time. ACP's resources and tools help you stay on top of PQRS reporting requirements and deadlines.