Master Core Curriculum

1. Master Core Curriculum Part B Basic Module 8 Medicare Resources

2. Presenting Organization • Speaker Name and Title

3. Learning Objectives • At the conclusion of this module, you will be able to: • Select Contractor resource(s) beneficial to your situation • Define the role of other agencies such as Program Safeguard and Claims Error Rate Testing Contractors • Select State and local resource(s) beneficial to yoursituation

4. Contractor Resources • Insert Information about your contractor web site here, include the following: • What’s New • Search function • Listservs • Educational resources and publications • Medical policies and Local Coverage Determination information

5. Contractor Resources • Navigate the website to locate information desired • www.cms.hhs.gov • CMS highlights • Frequently asked questions • Listservs • Educational resources and publications • Medical policies and local coverage determinations

6. CMS Highlights • CMS home page www.CMS.HHS.gov • Recent stories • Hot topics

7. Search Functions • Type the word or document you want to locate • Click Go • Advanced search • Determine how you want to limit the search (exact phrase, any words etc) • Modify the language, domain, occurrences and sorting preference(s)

8. Listservs • CMS offers an electronic mailing list service • From the CMS home page look for the main banner • Click on “Tools” • Under “Statewide Tools and Resources” click on “Mailing Lists”

9. Educational Resources Index • From the CMS home page select “Medicare” • Provides information such as: • General Information • Billing • Coding • Medicare Fee for Service Payment • Provider Enrollment and Certification • Health Plans

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11. Educational Resources and Publications – Medlearn Matters • From the home page you can link to the Medicare Learning Network • Located under “Outreach and Education” • Under the “Medicare Learning Network” select “Medlearn Matters Articles” • Designed to help providers understand new or changed Medicare policy • The articles are numbered in two ways: • Articles directly related to Change Requests (CRs) • Special Edition articles

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13. Educational Resources and Publications – Medicare Learning Network • From the Outreach and Education page • Select “Medlearn Products” • Select the type of Medlearn product you want to learn more about • Types of services include: • Web based training • Video / DVD resources • Many on-line publications are also available to order in print

14. Quarterly Provider Update (QPU) • From the CMS home page select “Regulations and Guidance” from the banner • Under “Policies” select “Quarterly Provider Updates” • Select the quarterly update to review

15. CMS Internet Only Manuals (IOM) • From the CMS home page select “Regulations and Guidance” from the banner • Next under “Guidance” select “Manuals” • On the left side of the screen under “Manuals” select “Internet-Only Manuals (IOMs)” • Select the publication that best describes what is being researched

16. Medical Policies and Local Coverage Determinations • National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) • Located in one database • From the CMS home page select “Tools” from the banner • Under “Medicare” select the “Medicare Coverage Database”

17. Unique Physician Identification Number (UPIN)/National Provider Identifier (NPI) • UPIN registry can be found from the Medicare Provider-Supplier Enrollment page • NPI information may be found by clicking on “Regulations & Guidance from the CMS home page

18. Medicare Physician Fee Schedule (MPFS) • Click on “Tools” from the CMS home page • Under Medicare select “Medicare Physician Fee Schedule Look-Up” • Follow the instructions to view the fee schedule amount of payment policy indicators for the HCPCS/CPT code in question

19. Contact Information • From the CMS home page select “Tools” • Then select “contacts Database” • Enter your state • Organization you are searching for • Type of contact • Locate your Carrier or other organization including: • Professional associations • Local contractors • CMS Regional Office contacts

20. Interact with Customer Service Professionals in the Contact Center • IVR (Interactive Voice Response) • Provider Customer Service • Beneficiary Customer Service

21. IVR • Eligibility inquiries must meet the privacy requirements • Providers are required to use the IVR to access this information provided in this manner • IVR can provide at a minimum the following: • Claims status • Beneficiary eligibility • The top 100 remittance advice code definitions • Helpful information to assist providers in resolving issues that can be automated

22. Provider Contact Center • Operation hours may vary from contractor to contractor • Provides both the provider contact center and the general written inquiries unit • Written inquiries include letters, faxes, and e-mail

23. Beneficiary Customer Service • Designed to assist Medicare beneficiaries with questions • To locate beneficiary contact information visit www.Medicare.gov • On the left hand column select “Search Tools”, then “Find Helpful Phone Numbers and Websites” • Select the contact needed then enter the state or location in question

24. Claims Error Rate Testing (CERT) Contractors • Calculates the Medicare Fee-For-Service error rate • Estimates improper claim payments • The CERT homepage can be found at www.cms.hhs.gov/CERT

25. Chapter References/Citations • www.cms.hhs.gov • www.Medicare.gov • Guide to Fee-for-Service Provider Information on the CMS and GPO websites