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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.
Medicare Identifier Lookup Tool
All Medicare Administrative Contractor (MAC) secure portal Medicare Beneficiary Identifier (MBI) look-up tools are ready for use through your MAC's portal. If CMS has mailed the new Medicare card, you can submit 4 data elements about your patient through the tool and get the MBI.
Quality Payment Program (QPP)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) to transition physicians away from a volume-based system toward one that rewards value.Learn more
Telehealth Guidance and Resources
Offering guidance on clinical use cases, technology, regulations and waivers, and billing and coding.
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
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
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.
Home Health Face-to-Face Encounter Requirement
Care Plan Oversight Encounter Worksheet and Instructions
Care Plan Oversight Encounter Worksheet and Instructions (ACP login required)