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Care Compare: Doctors and Clinicians Initiative CMS

Details: If you have any questions about public reporting for doctors and clinicians on Care Compare, contact the Quality Payment Program at 1-866-288-8292 or by e-mail at [email protected] To receive assistance more quickly, consider calling during non …

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Care-Compare-DAC-Initiative Go Now

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Physician Bonuses CMS

Details: Physician Health Professional Shortage Area Bonuses. Section 413 (b) of the Medicare Modernization Act (MMA) required CMS to revise some of the policies for the HPSA bonus payments. Section 1833 (m) of the Social Security Act provides bonus payments for physicians who furnish medical services in geographic areas that are designated by the

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National Provider Identifier Standard (NPI) CMS

Details: The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

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› Url: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand Go Now

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Ordering & Certifying CMS

Details: To qualify as an ordering and certifying provider, you’ll need to have an NPI, be enrolled in Medicare in an “approved” or “opt-out” status, and be of an eligible specialty type. The items and services you can order and certify will depend on your specialty type.

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Provider Enrollment and Certification CMS

Details: Information for Physicians, Practitioners, Suppliers, & Institutional Organizations. Access PECOS - the. Medicare Enrollment System. Become a Medicare. Provider or Supplier. Pay the Medicare. Application Fee. Revalidations (Renewing. Your Enrollment)

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List of CPT/HCPCS Codes CMS

Details: Physician Self Referral. Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law and commonly referred to as the “Stark Law”: Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an

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Your Medical Documentation Matters

Details: 12/9/2015 1 Your Medical Documentation Matters Presentation. Objectives. At the conclusion of this presentation, participants will be able to: • Identify Medicaid medical documentation rules

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› Url: https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/docmatters-presentation-handout.pdf Go Now

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Lookup tools CMS

Details: The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

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› Url: https://www.cms.gov/Medicare/Quality-Payment-Program/Lookup-Tools/Lookup-tools Go Now

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Non-Emergency Medical Transportation CMS

Details: Non-emergency medical transportation (NEMT) is an important benefit for people who need assistance getting to and from medical appointments. Our resources for providers explain important guidelines such as the difference between emergency and non-emergency medical transportation, accepted types of transportation, the types of transportation service delivery systems, and driver and …

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Telehealth Services

Details: Originating Sites An originating site is the location where a Medicare patient gets physician or practitioner medical services through a telecommunications system.

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SARS-CoV-2 DOCTOR’S OFFICE, TESTING HOSPITAL

Details: DOCTOR’S OFFICE, HOSPITAL • Medicare is separately paying hospitals and practitioners to assess patients and collect laboratory samples for COVID-19 testing even when that is the only service the patient receives. This approach supports both hospitals and physician practices to operate testing sites.

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› Url: https://www.cms.gov/files/document/43020-sars-cov-2-infographic.pdf Go Now

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Physician-Owned Hospitals CMS

Details: Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to qualify for the whole hospital and rural provider exceptions. A physician-owned hospital is now generally prohibited from expanding facility capacity. However, a physician-owned hospital that qualifies as an applicable …

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E-Prescribing CMS

Details: E-Prescribing is a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care - is an important element in improving the quality of patient care. The inclusion of electronic prescribing in the Medicare Modernization Act (MMA) of 2003 gave momentum to the

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NPI: What You Need to Know

Details: NPI: What You Need to no. MLN oolet Page 3 of 10. MLN909434 March 2021. Introduction. This booklet educates providers about the National Provider Identifier (NPI), who must get an NPI, and how

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Patient's Bill of Rights CMS

Details: The Departments of Health and Human Services, Labor and Treasury collaborated on the Patient’s Bill of Rights – which will help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it, protect all Americans’ choice of doctors, and end lifetime limits on the care consumers may receive.

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Patients-Bill-of-Rights Go Now

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Evaluation & Management Visits CMS

Details: This page contains guidance regarding documentation and payment under the Medicare Physician Fee Schedule for evaluation and management (E/M) visits.

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Health Care Payment and Remittance Advice and Electronic

Details: The health care payment and remittance advice transaction is the transmission of either: Payment, with information about the transfer of funds and payment processing from a health plan to a health care provider's financial institution. For an explanation of benefits or remittance advice from a health plan to a health care provider, see the EFT

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What You Should Know About Provider Networks

Details: doctor to see specialists. n Health Maintenance Organizations (HMOs): You’re usually limited to care from doctors who work for or contract with the HMO and are not covered for out-of-network care (except in an emergency). You may be required to live or work …

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› Url: https://marketplace.cms.gov/outreach-and-education/what-you-should-know-provider-networks.pdf Go Now

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Frequently Asked Questions CMS

Details: How is doctor, clinician, and group performance information displayed on Care Compare profile pages? Performance information for doctors, clinicians, and groups is displayed using measure-level star ratings, percent performance scores, and checkmarks. Specific information about how this performance information is publicly reported can be found

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Care-Compare-DAC-Initiative/Frequently-Asked-Questions Go Now

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11767 What You Should Know About Seeing a Doctor

Details: Know About Seeing Your Doctor. Most health plans give you the best deal on services when you see a doctor who has a contract with your health plan (also called an “in-network” provider). You may be able to see doctors who . don’t contract with your plan (called “out-of-network” providers), but if you do, you may pay higher out-of

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HealthCare.gov Pilots New Doctor Lookup Feature CMS

Details: “The Doctor Lookup feature at HealthCare.gov is a direct result of consumer demand,” said Kevin Counihan, CEO of the Health Insurance Marketplace. “Our goal is to provide consumers with relevant, personal and more up-to-date information about a plan before enrolling.

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Provider Data Catalog: Doctors & Clinicians Data

Details: 3 . Doctors and Clinicians National Downloadable File : Performance Year 2019 . The Doctors and Clinicians national downloadable file is organized at the individual clinician level; each line is unique at the

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› Url: https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/DOC_Data_Dictionary.pdf Go Now

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Medicaid Documentation for Medical Professionals

Details: 2. Prevent Problems—Self-Audit . Medical professionals have specific responsibilities when they accept reimbursement from a government program. They “have a duty to ensure that the claims submitted to Federal health care programs are true and accurate,”

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CMS Proposes Historic Changes to Modernize Medicare and

Details: Getting to the doctor can be a challenge for some beneficiaries, whether they live in rural or urban areas. Innovative technology that enables remote services can expand access to care and create more opportunities for patients to access personalized care management as well as connect with their physicians quickly.

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CMS Manual System

Details: (1) a) Doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs that function or action; or . b) Nurse practitioner who meets the training, education, and experience requirements as described in §410.75 (b). and

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› Url: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1885CP.pdf Go Now

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Find Your Taxonomy Code CMS

Details: Learn how to find your taxonomy code, and how to access the taxonomy code data set. A taxonomy code is a unique 10-character code that designates your classification and specialization. You will use this code when applying for a National Provider Identifier, commonly referred to as an NPI.

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Inpatient Admission and Medical Review Criteria

Details: •Physician who is a doctor of medicine or osteopathy •Dentist as specified at 42 CFR 424.13(d) •Doctor of podiatric medicine (if authorized under state law) •Must be responsible for the beneficiary or have sufficient knowledge of the case (and be authorized to certify) 10

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Physical, Occupational, and Speech Therapy Services

Details: All Therapy Services (PT,OT,SP) 5 Conditions of Coverage and Payment (42 CFR 424.24(c), 424.27 and SSA § 1835(a)(2)(D)) –Services are required based on individual needs

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The Affordable Care Act’s New Patient’s Bill of Rights CMS

Details: Remove insurance company barriers between you and your doctor. For plans starting on or after September 23, these rules ensure that you can choose the primary care doctor or pediatrician you want from your plan’s provider network, and that you can see an OB-GYN without needing a referral.

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Outpatient Rehabilitation Therapy Services: Complying with

Details: is a Doctor of Medicine, osteopathy, podiatric medicine, or optometry (only for low vision rehabilitation). An NPP is a physician assistant (PA), clinical nurse specialist (CNS) or nurse practitioner (NP). A qualified therapist includes a PT, OT, or SLP who meets regulatory qualifications (at 42 CFR

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Physician Self-Referral Law Frequently Asked Questions

Details: Q. If a hospital (or other Part A provider) directly employs or contracts with physicians to provide physician services to hospital patients, does that make the hospital

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Let Medicaid Give You a Ride

Details: Medicaid covers rides for eligible individuals to and from the doctor’s office, the . hospital, or another medical office for Medicaid-approved care. This coverage is called “non-emergency medical transportation,” because it does not involve a medical emergency. Medicaid may give you a ride if you do not have a car that works or do

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MLN8816413 – Checking Medicare Eligibility

Details: ecg Mecare gbt MLN act eet Page 4 of 5 MLN8816413 October 2021 ESRD data Therapy service Preventive services, HCPCS and or CPT codes, date of service, and National Provider Identifier (NPI)

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Medicare and Home Health Care

Details: Along with the doctor, home health staff create a plan of care, which is a written plan for your care. It tells what services you will get to reach and keep your best physical, mental, and social well-being. The home health staff keeps your doctor up-to-date on how you are doing and updates your plan of care as needed, as authorized by your doctor.

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Accountable Care Organizations and You: Frequently Asked

Details: If my doctor’s in an ACO, can I still see whatever doctor I want? Absolutely—if your doctor participates in an ACO, you can see any healthcare provider who accepts Medicare. Nobody—not your doctor, not your hospital—can tell you who you have to see. Is an ACO a Health Maintenance Organization (HMO), managed care or an insurance company? No.

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Referral of Patients for X-rays by Chiropractors

Details: doctor of medicine or osteopathy, even if the laws of the chiropractor’s state permit the chiropractor to order X-rays. • Not having a physician order the X-ray may result in lack of reimbursement. • The specific regulatory language from the regulation (42 CFR 410.32(a)) states as follows:

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