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Medicare Learning Network® (MLN)Suite of Products & Resources for Compliance Officers

What’s Inside the Suite?Experience here, a robust compilation of MLN products edited from our Catalog of Products. Each resource is designed to educate and address one of the many compliance issues facing providers today.

How Will the Suite Help Me?As a Fee-For-Service Provider, supplier or reimbursement specialist, these accurate and official products can assist you in understanding and streamlining the claims submission process, as well as enrich your understanding of initiatives and incentives.

Start Learning NowJust roll your cursor over one of the titles; click – and you are linked to a product. You can download information, listen to a podcast, research an article through MLN Matters®, or even sign up for a web-based training course – many of which offer continuing education credits. *Indicates an MLN Matters® Article

GENERAL COMPLIANCE RESOURCES

MLN Provider Compliance Web Page contains educational products that inform Medicare Fee-For-Service (FFS) providers on how to avoid common billing errors and other improper activities when dealing with the Medicare Program.

Medicare Quarterly Provider Compliance Newsletters help providers understand findings identified by Medicare Administrative Contractors (MACs), Recovery Auditors, Program Safeguard Contractors, Zone Program Integrity Contractors, the Comprehensive Error Rate Testing (CERT) review contractor and other governmental organizations, such as the Office of Inspector General.

MLN Matters® Articles are national articles designed to inform Medicare Fee-For-Service providers about the latest changes to the Medicare Program.

The Provider Compliance Group Interactive Map allows you to access state-specific CMS contractor contact information.

The Comprehensive Error Rate Testing (CERT) Reports includes the annual Improper Medicare Fee-For-Service Payment report.

Download Quick References Now

MLN HomepageWelcome to the MLN Homepage! The MLN is your destination for official CMS information and resources for Medicare Fee-For-Service (FFS) providers.

Medicare Coverage Database (MCD)A how-to guide to access information from the MCD; contains national and local Medicare coverage determinations, analyses, proposed decisions, coding analyses, and other information.

National Correct Coding Initiative (NCCI)A how-to guide to take advantage of the NCCI. The NCCI helps reduce coding errors and denials – and helps you ensure payments for covered services.

ICN 908525April 2013

http://go.cms.gov/MLNGenInfo

http://go.cms.gov/FastFactsWebCompliance

http://go.cms.gov/ComplianceNewsletterCompliance

http://go.cms.gov/MLNMattersCompliance

http://go.cms.gov/InteractiveMapCompliance

http://go.cms.gov/CERTReportCompliance


http://go.cms.gov/CoverageDatabaseInpatient

http://go.cms.gov/CoverageDatabaseInpatient

http://go.cms.gov/NCCIQuickRefInpatient

http://go.cms.gov/NCCIQuickRefInpatient


COMPLIANCE ISSUES AND CMS/MLN RESOURCES

SPECIALTY PRIMARY COMPLIANCE ISSUES MLN RESOURCES

Chiropractic • Coverage and payment • *SE1101 Overview of Medicare Policy requirements Regarding Chiropractic Services

• Chiropractic Services

Inpatient Rehabilitation • Identify coverage, payment, • Inpatient Rehabilitation Therapy Services: Therapy coding and billing requirements Complying with Documentation Requirements

Outpatient Rehabilitation Therapy • Outpatient Rehabilitation Therapy Services:

Complying with Documentation Requirements

Hospital • Assigning the correct patient • *SE0622 Clarification of Medicare Payment status code Policy When Inpatient Admission Is Determined

Not To Be Medically Necessary, Including the • Improper coding Use of Condition Code 44: “Inpatient Admission • Inpatient admission policy Changed to Outpatient”

• Medical necessity errors • *SE1121 [Revised], Recovery Audit Program Diagnosis Related Group (DRG) Coding Vulnerabilities for Inpatient Hospitals

• *SE0801 Clarification of Patient Discharge Status Codes and Hospital Transfer Policies

Visit here to register for free classes.

Hospital Specialties • Ambulance Services Separately Payable During an Inpatient Hospital Stay – Medicare Quarterly • AmbulanceCompliance Newsletter, Vol. 2, Issue 2, Jan. 2012, p. 1

Web-BasedTraining

Scroll down to section“Related Links” Select “Web-Based Training (WBT) Courses”

Popular Courses:

MedicareBillingCertificate Program for Part A and Part B Providers

*Diagnosis Coding: Using the ICD-9-CM

*HIPAA EDI Standards

*Medicare Fraud and Abuse

*Medicare Secondary Payer Provisions

Uniform Billing (UB-04)

*CertificateofMedicalNecessity

*World of Medicare

* Continuing Education Credits

http://go.cms.gov/SE0622Compliance










http://go.cms.gov/AmbulanceCompliance




http://go.cms.gov/WBTInpatient



http://go.cms.gov/ChiropracticCompliance

http://go.cms.gov/InpatientRehabCompliance



http://go.cms.gov/OutpatientRehabCompliance







• Cardiology • Diseases and Disorders of the Circulatory System Medicare Quarterly Compliance Newsletter, Vol. 2, Issue 2, Jan. 2012, p. 5

• General Surgery • Excisional Debridement - Medicare Quarterly Compliance Newsletter, Vol., 1, Issue 2, Feb. 2011, p. 5

• Evaluation and Management (E/M) Billing During the Global Surgery Period - Medicare Quarterly Compliance Newsletter, Vol. 1, Issue 2, Feb. 2011, p. 6

• Minor Surgery and Other Treatment Billed as Inpatient Stay - Medicare Quarterly Compliance Newsletter, Vol. 2, Issue 2, Jan. 2012, p. 9

• Acute Inpatient Neurological Disorders – • NeurologyMedically Unnecessary Items or Services provided in a Medically Unnecessary Setting – Medicare Quarterly Compliance Newsletter, Vol. 2, Issue 4, July 2012, p. 7

• Oncology • Chemotherapy Administration and Non- Chemotherapy Injections and Infusions - Medicare Quarterly Compliance Newsletter, Vol., 1, Issue 2, Feb 2011, p. 4

Web-BasedTraining


Popular Courses:








*World of Medicare


http://go.cms.gov/DiseasesDisordersCompliance



http://go.cms.gov/DebridementCompliance



http://go.cms.gov/EMCompliance




http://go.cms.gov/MinorSurgeryCompliance



http://go.cms.gov/AcuteInpatientCompliance





http://go.cms.gov/ChemotherapyCompliance









• Pulmonology • Tracheostomy – Incorrect Coding -Medicare Quarterly Compliance Newsletter, Vol., 1, Issue 2, Feb 2011, p. 2

• *SE1210 Recovery Auditors Findings Resulting • Urology from Medical Necessity Reviews of Renal and

Urinary Tract Disorders

Diagnostic Radiology in • Medical Record Documentation • *SE1134 [Revised] Medicare Payments for Emergency Departments Diagnostic Radiology Services in Emergency

• Physicians’ orders not present Departments

• Multiple claims for same interpretation submitted

Part A/Part B FFS • Illegible / missing signatures • Complying with Medicare Signature Providers Requirements

• Incorrect / no coding of Place of Service • *MM6698 [Revised] Signature Requirements for

Medical Review Purposes • Medical necessity

• *SE1226 Reminder of Importance of Correct Place of Service Coding on Medicare Part B

• Incorrect coding of E&M services Claims

• Place of Service Code Set

• *SE1104 The Importance of Correctly Coding the Place of Service by Physicians and Their Billing Agents

Web-BasedTraining


Popular Courses:








*World of Medicare



http://go.cms.gov/TracheostomyCompliance






http://go.cms.gov/SE1134MedicareCompliance



http://go.cms.gov/MedicareSignatureCompliance

http://go.cms.gov/MedicareSignatureCompliance

http://go.cms.gov/MM6698Compliance

http://go.cms.gov/MM6698Compliance




http://go.cms.gov/ServiceCodeCompliance








Part A/Part B FFS Providers • Illegible / missing signatures • Evaluation and Management (E/M) Services: Complying with Documentation Requirements

• Incorrect / no coding of Place of Service • Not a New Patient, Medicare Quarterly

Compliance Newsletter, Vol., 1, Issue 2, • Medical necessity Feb. 2011, p. 3

• Incorrect coding of E&M services

DME Medical Suppliers • Questionable billing • Billing for Arformoterol (Brovana) (J7605) and • Not following documentation Formoteral fumarate (Perforomist) (Q4099) -

requirements Medicare Quarterly Compliance Newsletter, Vol. 2, Issue 2, Jan. 2012, p. 3 • Not following coverage

requirements• Budesonide - Dose vs. Billed Units, Medicare

Quarterly Compliance Newsletter, Vol. 1, Issue 2, Feb. 2011, p. 8

• *SE1103 [Revised] Capped Rental DME: Enforcement of Payment Requirements for Beneficiary-owned Capped Rental Durable Medical Equipment (DME)

• Durable Medical Equipment (DME) While Patient Is Receiving Care from a Hospice Provider, Medicare Quarterly Compliance News-letter, Vol., 1, Issue 2, Feb 2011, p. 7

• Lower Limb Suction Valve Prosthesis - Medicare Quarterly Compliance Newsletter, Vol. 2, Issue 2, Jan. 2012, p. 7

Web-BasedTraining


Popular Courses:








*World of Medicare



http://go.cms.gov/ArformoterolCompliance




http://go.cms.gov/BudesonideCompliance







http://go.cms.gov/DMECompliance




http://go.cms.gov/LowerLimbCompliance



http://go.cms.gov/EvaluationServicesCompliance

http://go.cms.gov/EvaluationServicesCompliance

http://go.cms.gov/NotaNewPatientCompliance







DME Medical Practitioner • Questionable billing • Cardiac Pacemakers: Complying with • Not following documentation Documentation & Coverage Requirements

requirements

• Not following coverage • *SE1213 Questionable Billing By Suppliers of requirements Lower Limb Prostheses

• Glucose Testing Supplies

• Oxygen Therapy Supplies: Complying with Documentation & Coverage Requirements

• Oxygen Therapy Supplies: Complying with Documentation & Coverage Requirements - Podcast

• *SE1112 Power Mobility Device Face-to-Face Examination Checklist

Web-BasedTraining


Popular Courses:








*World of Medicare



http://go.cms.gov/CardiacPacemakerCompliance

http://go.cms.gov/CardiacPacemakerCompliance



http://go.cms.gov/GlucoseTestingCompliance

http://go.cms.gov/OxygenTherapyCompliance

http://go.cms.gov/OxygenTherapyCompliance

http://go.cms.gov/OxygenPodcastCompliance





DME Medical Suppliers & • Questionable billing • Power and Mobility Devices: Complying with Practitioner • Not following documentation Documentation and Coverage Requirements

requirements• Not following coverage • Positive Airway Pressure (PAP) Devices:

requirements Complying with Documentation & Coverage Requirements

• Positive Airway Pressure (PAP) Devices: Complying with Documentation & Coverage Requirements - Podcast



Learn more. Stay connected.Check out CMS on



Popular Courses:








*World of Medicare

Web-BasedTraining



Visit the Medicare Learning Network® (MLN)http://go.cms.gov/MLNGenInfo

http://go.cms.gov/PowerMobilityCompliance

http://go.cms.gov/PowerMobilityCompliance

http://go.cms.gov/PAPCompliance



http://go.cms.gov/PAPDeviceCompliance




http://www.cms.gov/


http://www.hhs.gov/

http://www.linkedin.com/groups?gid=966657&mostPopular=&trk=tyah

https://twitter.com/CMSGov

http://www.youtube.com/user/CMSHHSgov

http://www.flickr.com/photos/christianacare/6835846135/in/set-72157629215726807/



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