CMS Links - JD DME

Centers for Medicare & Medicaid Services (CMS) - CMS provides direction and technical guidance for the administration of the Federal effort to plan, develop, manage and evaluate health care financing programs and policies.

Contacts Database - Search the CMS.gov Contacts Database by state/territory, contact type, organization type and organization name.

All Fee-for-Service Providers - Important Medicare Fee-for-Service links.

Coordination of Benefits (COB) & Recovery Overview - The Medicare Secondary Payer (MSP) program is in place to ensure that Medicare is aware of situations where it should not be the primary, or first, payer of claims. If a beneficiary has Medicare and other health insurance, Coordination of Benefits (COB) rules decide which entity pays first. There are a variety of methods and programs used to identify situations in which Medicare beneficiaries have other insurance that is primary to Medicare. Activities related to the collection, management, and reporting of other insurance coverage for Medicare beneficiaries is performed by the Benefits Coordination & Recovery Center (BCRC).

DME Center - Links to DME-specific information

DMEPOS Competitive Bidding - Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and CMS awards contracts to enough suppliers to meet beneficiary demand for the bid items.

Electronic Billing & EDI Transactions - The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors.

Electronic Mailing Lists - Sign up to receive consistent and accurate information from CMS regarding news, policy changes and updates.

Medicare Advantage Plan Directory - This directory contains information for Medicare Advantage, demonstration, PACE, and cost organizations that have an active contract with CMS at the time of the directory's publication.

Medicare Learning Network (MLN) - The MLN is the home for education, compliance information and resources for the health care professional community. The MLN offers:

• MLN Educational Products, including MLN Matters Articles
• MLN Connects Provider Association Partnerships
• MLN Connects Newsletter
• Provider electronic mailing lists

Open Payments Program - Open Payments is a national disclosure program that promotes transparency by publishing the financial relationships between the medical industry and healthcare providers (physicians and hospitals) on a publicly accessible website developed by CMS.

Prescription Drug Coverage - General Information - The MMA legislation provides seniors and people with disabilities with the first comprehensive prescription drug benefit ever offered under the Medicare program, the most significant improvement to senior health care in nearly 40 years.

Provider-Supplier Enrollment - Provides Medicare enrollment information for providers, physicians, non-physician practitioners, and other suppliers.

Quality Initiatives - The various Quality Initiatives touch every aspect of the healthcare system.

Quality Payment Program - Prior to the Quality Payment Program (QPP), payment increases for Medicare services were set by the Sustainable Growth Rate (SGR) law. This capped spending increases according to the growth in the Medicare population, and a modest allowance for inflation.

HIPAA - General Information - The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) require the Department of Health and Human Services (HHS) to adopt national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. To date, the implementation of HIPAA standards has increased the use of electronic data interchange.

Internet Only Manuals (IOM) - The CMS Online Manual System is used by CMS program components, partners, contractors, and State Survey Agencies to administer CMS programs. It offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. In 2003, we transformed the CMS Program Manuals into a web user-friendly presentation and renamed it the CMS Online Manual System.

Legislative Update - The purpose of the Legislative Update is to provide the public and other interested parties with up-to-date information on CMS' efforts to implement new legislation, including PPACA, TRHCA, and DRA. It will contain information on published regulations, policy instructions, key implementation dates, and other accomplishments that relate to new legislation.

Manuals - Medicare program instructions, policies and procedures based on statutes and regulations, guidelines and directives are contained on this Web site. CMS contractors, such as Noridian, use these program instructions to administer CMS programs.

Medicare Contracting Reform - CMS' mission is to ensure health care security for beneficiaries. A major component in achieving this mission is the successful administration of Original Medicare, or Fee-for-Service (FFS) Medicare. Medicare Contracting Reform (or section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) is a major component in achieving this mission.

National Provider Identifier Standard (NPI) - The NPI is a HIPAA Administrative Simplification Standard. It is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. 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.

Regulations & Guidance - Links to manuals, legislation and much more

ICD-10 - Here you will find resources to help, Providers, Payers, and Vendors with the U.S. health care industry's transition to ICD-10 on October 1, 2015.

Medically Unlikely Edits (MUEs) - The CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. All HCPCS/CPT codes do not have an MUE. MUE was implemented January 1, 2007 and is utilized to adjudicate claims at Carriers, Fiscal Intermediaries, and DME MACs.

Medicare Coverage Database (MCD) - The MCD contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions. The database also includes several other types of National Coverage policy related documents, including National Coverage Analyses (NCAs), Coding Analyses for Labs (CALs), Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) proceedings, and Medicare coverage guidance documents.

National Correct Coding Initiative (NCCI) Edits - The purpose of the NCCI edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services. The Column One/Column Two Correct Coding Edits table and the Mutually Exclusive Edits table have been combined into one table and include code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual.

National Coverage Determinations (NCDs) - A listing of the National Coverage Determinations implemented by CMS.

Physician Fee Schedule - The information that is provided on the physician fee schedule (PFS) web page relates to payment under the PFS and related information concerning the development of the payment amounts. This information is intended for physicians/non-physicians who provide services to Medicare beneficiaries. This information is updated on regular basis when there are payment/policy changes.

Prospective Payment Systems - General Information - A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount.
ZIPCODE TO CARRIER LOCALITY FILE - This file is primarily intended to map ZIP Codes to CMS carriers and localities. This file will also map Zip Codes to their State. In addition, it contains an urban, rural or a low density (qualified) area Zip Code indicator.

Transmittals - CMS uses transmittals to communicate new or changed policies or procedures that we will incorporate into the CMS Online Manual System. The cover or transmittal page summarizes and specifies the changes.

Medicare Remit Easy Print (MREP) Software information - CMS presents the Medicare Remit Easy Print (MREP) software to view and print the Health Insurance Portability and Accountability Act (HIPAA) compliant 835 for professional providers and suppliers. This software, which is available for free to Medicare providers and suppliers, can be used to access and print remittance advice information, including special reports, from the HIPAA 835.

Quality Improvement Organizations (QIOs) - By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.

CMS Regional Offices - CMS has ten Regional Offices (ROs) reorganized in a Consortia structure based on the Agency's key lines of business:

• Medicare Health Plans Operations,
• Financial Management and Fee For Service Operations,
• Medicaid and Children's Health Operations, and
• Quality Improvement and Survey & Certification Operations.

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