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CMS Links

Noridian believes providers/suppliers should have access to as many resources as possible and have provided hyperlinks to relevant Medicare websites.

Program Information

Program Information Details
Centers for Medicare & Medicaid Services (CMS) This link will take you to an external website. 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 This link will take you to an external website. Search the CMS.gov Contacts Database by state/territory, contact type, organization type and organization name.
All Fee-for-Service Providers This link will take you to an external website. Important Medicare Fee-for-Service links.
Coordination of Benefits (COB) & Recovery Overview This link will take you to an external website.

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 This link will take you to an external website. Links to DME-specific information
DMEPOS Competitive Bidding This link will take you to an external website. 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 This link will take you to an external website. 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 Fact Sheet This link will take you to an external website. Sign up to receive consistent and accurate information from CMS regarding news, policy changes and updates.
Frequently Asked Questions This link will take you to an external website. Search the CMS FAQ database for answers to commonly asked questions.
Medicare Advantage Plan Directory This link will take you to an external website. 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 Administrative Contractor Satisfaction Indicator (MSI) This link will take you to an external website.

The MSI a survey designed to collect quantifiable data on provider satisfaction with the performance of Medicare fee-for-service contractors.

Medicare Learning Network (MLN) This link will take you to an external website.

The MLN is the home for education, compliance information and resources for the health care professional community. The MLN offers:

MLN Guided Pathways Booklet This link will take you to an external website. CMS has put booklets together incorporating existing MLN products and other CMS resources into organized sections that can help Medicare FFS providers find information to understand and navigate the Medicare Program.
Open Payments Program This link will take you to an external website. 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.
Physician Quality Reporting System (PQRS) This link will take you to an external website. The Physician Quality Reporting System (Physician Quality Reporting or PQRS) is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals.
Prescription Drug Coverage – General Information This link will take you to an external website. 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 This link will take you to an external website. Provides Medicare enrollment information for providers, physicians, non-physician practitioners, and other suppliers.
Quality Initiatives This link will take you to an external website. The various Quality Initiatives touch every aspect of the healthcare system.

 

Regulations

Regulations Details
HIPAA – General Information This link will take you to an external website. 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) This link will take you to an external website.  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 This link will take you to an external website. 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 This link will take you to an external website. 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 This link will take you to an external website. 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) This link will take you to an external website. 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 This link will take you to an external website. Links to manuals, legislation and much more

 

Coverage

Coverage Details
ICD-10 This link will take you to an external website. 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, 2014.
Medically Unlikely Edits (MUEs) This link will take you to an external website.

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) This link will take you to an external website. 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 This link will take you to an external website. 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) This link will take you to an external website. A listing of the National Coverage Determinations implemented by CMS.
Physician Fee Schedule This link will take you to an external website. 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 This link will take you to an external website.

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.

Quarterly Provider Update (QPU) This link will take you to an external website. CMS publishes this update at the beginning of each quarter to inform the public about regulations and major policies currently under development, regulations and major policies completed or cancelled and new/revised manual instructions.
Transmittals This link will take you to an external website. 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.

 

Remittance Advice

Remittance Advice Details
Medicare Remit Easy Print (MREP) Software information This link will take you to an external website. 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.

 

Additional Resources

Additional Resources Details
Quality Improvement Organizations (QIOs) This link will take you to an external website. By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.

Regional Offices This link will take you to an external website.

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.

 

Last Updated Sep 13, 2016