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Resource CMS Medicare Claims Processing Manual

Medicare Claims Processing Manual

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912

DOWNLOAD PDF LINKS AVAILABLE

General Billing Requirements

Admission and Registration Requirements

Inpatient Hospital Billing

Part B Hospital (Including Inpatient Hospital Part B and OPPS)

Part B Outpatient Rehabilitation and CORF/OPT Services

Inpatient Part A Billing and SNF Consolidated Billing



SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule)

Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims

Rural Health Clinics/Federally Qualified Health Centers

Home Health Agency Billing

Processing Hospice Claims

Physicians/Nonphysician Practitioners

Radiology Services and Other Diagnostic Procedures

Ambulatory Surgical Centers

Ambulance

Laboratory Services

Drugs and Biologicals

Preventive and Screening Services

Durable Medical Equipment, Prosthetics, Orthotics and Supplies

Medicare Summary Notices

Remittance Advice

Fee Schedule Administration and Coding Requirements

General EDI and EDI Support Requirements, Electronic Claims and Coordination of Benefits Requirements, Mandatory Electronic Filing of Medicare Claims

Completing and Processing the Form CMS-1450 Data Set

Completing and Processing Form CMS-1500 Data Set

Contractor Instructions for CWF

Coordination With Medigap, Medicaid, and Other Complementary Insurers

Appeals of Claims Decisions

Financial Liability Protections

ANSI X12N Formats Other Than Claims or Remittance

Billing Requirements for Special Services

Miscellaneous Hold Harmless Provisions

Reopening and Revision of Claim Determinations and Decisions

Independent Diagnostic Testing Facility

Competitive Bidding

Department of Veterans Affairs (VA) Claims Adjudication Services Project

Emergency Preparedness Fee-For-Service Guidance

Opioid Treatment Programs
 
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