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Fact Sheets Search Criteria:
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Title: 72 Hour Rule - Outpatient Services Treated As Inpatient Services
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Summary: All services provided within 72 hours of the inpatient admission are considered part of the inpatient service and are required to be billed on one claim. This fact sheet explains the 72-hour rule and gives appropriate billing instructions.
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Revision Date : 8/24/2006
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Title: Acronyms
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Summary: The Acronym fact sheet contains a listing of acronyms and abbreviations.
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Revision Date : 2/12/2007
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Title: Additional Development Request Fact Sheet
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Summary: This fact sheet describes the Additional Development Request process and procedures.
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Revision Date : 10/21/2005
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Title: Adjusting Paid Claims Online
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Summary: This job aid provides instructions for adjusting and canceling paid claims (PB9997) online.
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Revision Date : 6/13/2008
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Title: Advanced Beneficiary Notices (ABNs) VS Notice of Non-Coverage
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Summary: The Fact sheet informs providers of the differences between ABNs & Notices of Non-Coverage. It also discusses examples of how to bill certain services that may not be covered by Medicare, and what may happen to their claim if billed incorrectly.
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Revision Date : 2/20/2008
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Title: Bad Debt Fact Sheet
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Summary: The Bad Debt Fact Sheet describes the standards for claiming bad debts on a cost report.
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Revision Date : 9/13/2007
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Title: BCBSA's Case Study for the Form CMS-2552-96 (T.10)
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Summary: This case study will assist you in learning all of the major revisions to the Hospital and Hospital Health Care Complex Cost Report necessary to implement recent laws and regulations.
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Revision Date : 10/29/2003
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Title: Case Study for Form CMS-2540-96 (T.11)
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Summary: This case study will assist you in learning all of the major revisions to the Skilled Nursing Facility (SNF) cost report necessary to implement provisions enacted by the BBRA '1999, BIPA '2000, HHA-PPS and SNF-based hospice cost reporting requirements.
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Revision Date : 6/21/2002
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Title: Claims Adjustments and Cancels
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Summary: Adjustments are the most common mechanism for changing a previously accepted bill. A claim cannot be adjusted or voided unless it has been finalized and is reflected on the remittance advice.
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Revision Date : 6/2/2005
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Title: Clinical Diagnostic Laboratory Services National Coverage Determinations (NCDs) Claims Processing/Reason Codes
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Summary: The fact sheet informs providers of the different reason codes that they may receive based on the edit module and the ability to submit additional documentation to support medical necessity via NCD DOC.
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Revision Date : 9/15/2004
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Title: Comprehensive Error Rate Testing (CERT)
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Summary: This fact sheet informs providers of the Comprehensive Error Rate Testing (CERT) program.
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Revision Date : 8/28/2006
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Title: Contact Us - Email Inquiries
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Summary: The Contact Us fact sheet provides instructions for submitting questions of a general nature via email. It also gives instructions for referencing and searching the FAQ database.
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Revision Date : 2/2/2004
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Title: Correcting RTP'd - Responding to ADR's Online
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Summary: This job aid provides detailed instructions for correcting RTP'd claims (TB9997) online and responding to Medical Review ADR's (SB6001) online.
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Revision Date : 6/11/2008
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Title: Coverage of Influenza and Pneumococcal Vaccines
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Summary: The Coverage of Influenza and Pneumococcal Vaccines fact sheet explains who can administer the vaccines, how many vaccines Medicare will cover, and what the beneficiary will owe.
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Revision Date : 2/13/2007
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Title: Credit Balance Report
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Summary: The Credit Balance fact sheet covers the most frequently asked questions on Credit Balance reporting.
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Revision Date : 4/28/2008
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Title: Critical Access Hospital (CAH) Resource Guide
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Summary: This fact sheet contains resources to help providers locate CMS regulations relating to Critical Access Hospitals (CAH).
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Revision Date : 12/21/2006
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Title: Critical Access Hospital Method II Reimbursement
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Summary: This fact sheet contains billing guidelines for Critical Access Hospitals that are planning or have chosen the optional billing method for their reimbursement.
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Revision Date : 2/6/2006
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Title: CRNA Fact Sheet
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Summary: The CRNA fact sheet provides guidance on how to qualify for reimbursement related to the services of Certified Registered Nurse Anesthetists (CRNA) or Anesthesiologist’s Assistants.
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Revision Date : 3/27/2008
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Title: DDE (Direct Data Entry) Online Manual
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Summary: This job aid provides instructions for accessing the FISS (Fiscal Intermediary Standard System) DDE Online Manual.
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Revision Date : 3/20/2006
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Title: DDE Signon
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Summary: The DDE Signon Fact Sheet provides step-by-step routine signon instructions. It also outlines steps for password reset if your CDS userid has been revoked.
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Revision Date : 5/12/2008
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Title: Do You Have HCPCS Coding Questions?
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Summary: A clearinghouse has been established by the American Hospital Association (AHA) to field coding questions on HCPCS usage.
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Revision Date : 3/2/2006
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Title: EMC Fact Sheet
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Summary: This fact sheet provides information about the EMC (Electronic Media Claims) process, how to enroll, electronic format requirements, and software options.
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Revision Date : 6/10/2008
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Title: ERA Fact Sheet
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Summary: This fact sheet contains some of the most frequently asked questions and answers related to the ERA (Electronic Remittance Advice). It provides information on setup, version and format, and software.
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Revision Date : 6/10/2008
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Title: ESRD Coordination Period
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Summary: This information is provided to assist in understanding the coordination period for Medicare beneficiaries entitled due to End Stage Renal Disease (ESRD).
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Revision Date : 8/27/2007
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Title: Filing Cost Reports
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Summary: This fact sheet gives information about proper filing of cost reports including if you should file, when you should file, acceptability, and submitting payment with your cost report.
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Revision Date : 5/14/2008
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Title: Finding Bulletins On Trispan.com
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Summary: This fact sheet explains registering for email notification, searching for a bulletin, and contacting TriSpan Health Services through the website if you have a problem locating a bulletin or have other questions.
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Revision Date : 5/10/2006
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Title: Finding LCDs on TriSpan.com
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Summary: This fact sheet explains registering for email notification, searching for an LCD bulletin, and contacting TriSpan Health Services through the website if you have a problem locating an LCD bulletin or have other questions.
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Revision Date : 5/9/2006
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Title: FISS Function Keys and System Menus
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Summary: The FISS Function Keys and Systems Menus fact sheet contains a list of options for inquiries, claims entry, and claims correction. It also identifies common claim status locations, payer codes, and function keys.
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Revision Date : 3/20/2006
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Title: Freedom of Information Requests
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Summary: Fact sheet for Freedom of Information requests gives information about what the requesting person must submit, potential cost of the information requested, the correct mailing address for the FOI and the length of time required to complete the request.
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Revision Date : 6/4/2008
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Title: Health Insurance Claim Number (HICN) Prefixes and Suffixes
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Summary: This fact sheet provides the meanings for each prefix or suffix that may be attached to the Health Insurance Claim Number (HICN).
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Revision Date : 6/18/2007
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Title: HIPAA FAQs
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Summary: This job aid provides answers to some of the most general questions asked regarding HIPAA compliance.
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Revision Date : 1/27/2003
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Title: How to Appeal a Claim
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Summary: The How to Appeal a Claim fact sheet explains the appeals process, including the different levels of appeal, time requirements for filing an appeal, and the required amounts in controversy.
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Revision Date : 1/8/2008
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Title: How to Appeal a Cost Settlement Fact Sheet
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Summary: This fact sheet relates information about appealing a cost settlement.
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Revision Date : 5/28/2008
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Title: ICD-9 Coding Compliance Tips
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Summary: This fact sheet contains tips for our providers in ICD-9 coding and compliance. Some subjects are internal processes that should be followed, suggestions for coders regarding HIPAA guidelines, and the danger of internal cheat sheets.
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Revision Date : 5/8/2003
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Title: Identifying Outdated Bulletins, Superseded Bulletins, or
Retired Local Medical Review Policies
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Summary: This fact sheet communicates the method used to identify bulletins that are no longer current. We have added a "stamp" to identify bulletins that have been outdated or superseded and retired LMRPs.
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Revision Date : 9/15/2004
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Title: Infusion Therapy and Diagnostic Injections
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Summary: This fact sheet contains billing guidelines for infusion therapy and diagnostic injections. Infusion therapy codes discussed are Q0081, Q0083, and Q0084. Diagnostic codes discussed are 90782, 90783, 90784, 90788, and 90799.
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Revision Date : 2/6/2006
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Title: Inpatient Psychiatric Facilities (IPF) Resource Guide
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Summary: This fact sheet contains resources to help providers locate CMS regulations relating to Inpatient Psychiatric Facilities (IPF).
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Revision Date : 12/21/2006
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Title: Inpatient Rehabilitation Facilities (IRFS) Resource Guide
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Summary: This fact sheet contains resources to help providers locate CMS regulations relating to Inpatient Rehabilitation Facilities (IRF).
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Revision Date : 12/21/2006
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Title: Inpatient Rehabilitation Facility (IRF) Admission Quick Reference
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Summary: This fact sheet provides a quick reference guide to assist providers in admitting patients appropriately to IRFs. For coverage and medical necessity guidelines, refer to the Inpatient Rehabilitation Facility Services Local Coverage Determination.
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Revision Date : 12/20/2005
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Title: Inquiries Related to Specific Coding, CCI Edits and Outpatient Code Edits (OCE)
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Summary: This fact sheet explains the CMS policy for Customer Service Representatives regarding specific coding questions. It provides references for CCI edit questions and for OCE questions, including the NTIS website and the Medicare Learning network.
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Revision Date : 7/23/2002
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Title: Late Filed Cost Report Fact Sheet
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Summary: The Late Filed Cost Report fact sheet provides information on interest calculation and procedures for submitting a cost report after its due date.
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Revision Date : 2/9/2006
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Title: Local Coverage Determination (LCD) Reconsideration Process
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Summary: This fact sheet includes an overview and instructions for requesting a LCD reconsideration, effective October 1, 2002. The LCD Reconsideration Process is a mechanism by which interested parties can request a revision to a final LCD.
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Revision Date : 2/28/2006
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Title: LTCH 3 Day or Less Interruption of Stay Policy
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Summary: This policy covers LTCH discharges and readmissions to the same LTCH within 3 days.
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Revision Date : 11/30/2007
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Title: LTCH Greater Than 3 Day Interruption of Stay Policy
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Summary: This policy covers LTCH discharges and immediate admissions to an acute care hospital, inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF)/ swingbed followed by readmission to the same LTCH after 3 days.
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Revision Date : 11/30/2007
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Title: Mammogram Fact Sheet
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Summary: This fact sheet describes the coverage policy for mammograms.
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Revision Date : 7/6/2005
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Title: Medical Review New Provider Information
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Summary: This fact sheet provides information regarding core Medical Review functions and processes. It includes information on Progressive Correction Action, Additional Development Requests, Local Coverage Determinations, and "Contact Us."
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Revision Date : 1/29/2007
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Title: Medicare Advantage (MA) Plans
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Summary: This fact sheet defines Medicare Advantage (MA) Plans and provides resources and information for providers who treat beneficiaries enrolled in these plans. It addresses bad debts and cost report questions.
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Revision Date : 9/19/2006
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Title: Medicare Fraud
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Summary: This fact sheet defines fraud and provides examples of fraud such as: improper billing, falsifying records, and cost report issues.
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Revision Date : 5/26/2006
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Title: Medicare Prescription Drug Program
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Summary: This fact sheet contains helpful questions and answers regarding the new Medicare Prescription Drug Program
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Revision Date : 2/2/2006
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Title: MSP Questionnaire
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Summary: This fact sheet, designed for beneficiaries, describes situations in which Medicare is not the primary payer. The Medicare Secondary Payer (MSP) department helps ensure that the right payer is billed first.
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Revision Date : 3/23/2004
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Title: MSP Reference Guide
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Summary: This fact sheet instructs the billing staff with step-by-step procedures on how to submit a claim where MSP is involved.
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Revision Date : 8/22/2007
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Title: Premier Edition Medlearn Matters Number: SE0401
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Summary: CMS and your Medicare Learning Network introduces Medlearn Matters. Information for Medicare Providers, a new educational resource for Providers. It is designed to inform you of important changes to the Medicare system in a user-friendly format.
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Revision Date : 3/4/2004
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Title: Prepare for your Workshop Experience
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Summary: This fact sheet provides helpful tips in preparing for Medicare workshops.
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Revision Date : 8/16/2005
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Title: Privacy Act and Address Changes
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Summary: This Fact Sheet provides general information regarding the Privacy Act and address correction guidelines. It also gives brief definitions of what verbal and written consents are, as well as, what a Power of Attorney is.
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Revision Date : 6/20/2007
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Title: Program Safeguard Contractors
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Summary: This fact sheet defines a Program Safeguard Contractor (PSC), explains the PSC responsibilities versus TriSpan's, and provides contact information for the three PSCs for our tri-regional area.
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Revision Date : 5/26/2006
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Title: Provider Claims and Billing Inquiries
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Summary: The Provider Claims and Billing Inquiries fact sheet gives providers options to use direct automated tools for routine inquiries rather than calling the Customer Service unit.
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Revision Date : 10/31/2005
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Title: Provider Enrollment
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Summary: Provides basic provider enrollment information and links to access the CMS 855A and the CMS web site for provider enrollment.
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Revision Date : 2/9/2006
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Title: Provider Outreach & Education Advisory Group (POE AG)
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Summary: This fact sheet gives a detailed explanation of the Provider Outreach and Education Advisory Group's (POE AG) responsibilities. It also gives a list of the POE AG members and organization names.
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Revision Date : 10/3/2008
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Title: Provider/Supplier Web Pages
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Summary: CMS wants to ensure providers have quick access to accurate Medicare program information. These provider and supplier-specific Web pages are a resource focused on the informational needs and interests of providers and other practitioners.
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Revision Date : 2/7/2006
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 1st Quarter 2007
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Summary: This fact sheet lists the specific reasons for CERT errors from October through December 2006 broken down by type of bill.
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Revision Date : 1/29/2007
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 1st Quarter 2008
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Summary: This fact sheet lists the specific reasons for CERT errors from October through December 2007 broken down by type of bill.
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Revision Date : 1/10/2008
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 2nd Quarter 2007
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Summary: This fact sheet lists the specific reasons for CERT errors from January through March 2007 broken down by type of bill.
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Revision Date : 5/18/2007
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 2nd Quarter 2008
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Summary: This fact sheet lists the specific reasons for CERT errors from January through March 2008 broken down by type of bill.
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Revision Date : 7/15/2008
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 3rd Quarter 2007
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Summary: This fact sheet lists the specific reasons for CERT errors from April through June 2007 broken down by type of bill.
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Revision Date : 8/7/2007
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 3rd Quarter 2008
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Summary: This fact sheet lists the specific reasons for CERT errors from April through June 2008 broken down by type of bill.
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Revision Date : 7/15/2008
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 4th Quarter 2007
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Summary: This fact sheet lists the specific reasons for CERT errors from July through September 2007 broken down by type of bill.
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Revision Date : 10/24/2007
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Title: Reasons for Comprehensive Error Rate Testing (CERT) Errors 4th Quarter 2008
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Summary: This fact sheet lists the specific reasons for CERT errors from July through September 2008 broken down by type of bill.
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Revision Date : 10/20/2008
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Title: Roster Billing for Influenza Claims
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Summary: The "Roster Billing Requirements for Influenza Claims" fact sheet provides information regarding how to file roster bills for flu vaccines and provides an example of a claim form and roster.
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Revision Date : 6/9/2008
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Title: Roster Billing Requirements for Pneumococcal Pneumonia Vaccine (PPV) Claims
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Summary: The "Roster Billing Requirements for Pneumonia Vaccine (PPV) Claims" fact sheet provides information regarding how to file roster bills for pneumonia vaccines, and provides an example of a claim form and roster.
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Revision Date : 6/9/2008
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Title: Routine vs. Non-routine Supplies
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Summary: This fact sheet provides information regarding the billing and examples of routine and non-routine supplies.
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Revision Date : 1/3/2007
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Title: Rural Health Clinics (RHCs) Resource Guide
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Summary: This fact sheet contains resources to help providers locate CMS regulations relating to Rural Health Clinics (RHC).
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Revision Date : 12/21/2006
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Title: Skilled Nursing & Swing Bed Facilities (SNFs) Resource Guide
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Summary: This fact sheet contains resources to help providers locate CMS regulations relating to Skilled Nursing and Swing Bed Facilities (SNF).
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Revision Date : 12/21/2006
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Title: Skilled Nursing Facility (SNF) No-Payment Bills
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Summary: This Fact Sheet is to be used as a reference by SNFs when submitting No-Payment bills.
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Revision Date : 11/30/2007
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Title: SKILLED NURSING FACILITY ADDITIONAL DEVELOPMENT REQUEST QUICK REFERENCE
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Summary: TriSpan developed a Fact Sheet or Quick Reference Guide for Skilled Nursing Facility (SNF) providers to use to ensure that the appropriate requested documentation is submitted for review.
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Revision Date : 9/8/2004
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Title: Smoking and Tobacco-Use Cessation Counseling Services
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Summary: This Fact Sheet explains the requirements beneficiaries must meet in order to receive counseling services for smoking and tobacco-use. It provides billing guidelines for those services.
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Revision Date : 2/6/2006
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Title: SNF/Swing Bed PPS Consolidated Billing
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Summary: The SNF Swing Bed PPS Consolidated Billing fact sheet describes the requirements for consolidated billing in skilled nursing facilities.
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Revision Date : 3/19/2003
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Title: Sulzer Orthopedics
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Summary: This fact sheet provides the procedures that are required for attorneys that are representing a Medicare beneficiary as a client in a liability case related to certain recalled Sulzer Inter-Op acetabular shells for hip implants.
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Revision Date : 3/23/2004
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Title: Top 10 Claim Denial Reason Codes 4th Quarter 2008
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Summary: This fact sheet provides the top 10 reasons for claim denials from July through September 2008. It includes education on how to prevent complex and automated review denials based on National Coverage Determinations and Local Coverage Determinations.
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Revision Date : 10/20/2008
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Title: Top 20 Returned to Provider (RTP) Reason Codes
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Summary: To assist providers in understanding and correcting billing errors for the top 20 RTP (Returned to Provider) reason codes. Includes plain language reason code descriptions and plain language solution steps.
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Revision Date : 4/18/2008
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Title: Top 5 Returned to Provider (RTP) Medicare Code Editor Reason Codes
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Summary: This Fact Sheet will outline the Top 5 Returned to Provider Medicare Code Editor Reason Codes and give a brief solution to resolve these edits.
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Revision Date : 8/30/2007
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Title: VRU (Voice Response Unit)
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Summary: The VRU (Voice Response Unit) fact sheet provides information that will give you instruction on how to access the claims status, benefits & eligibility information.
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Revision Date : 5/22/2008
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Title: Waiver and Appeal Fact Sheet
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Summary: This fact sheet describes the circumstances under which it would be appropriate to ask for a waiver or to appeal a claims determination.
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Revision Date : 3/1/2002
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Title: What Should I Know About Sanctions and Exclusions?
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Summary: Information contained in this fact sheet includes how to search the sanctions database and the effect of employing a sanctioned provider in your facility.
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Revision Date : 9/26/2003
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