Medicare compliance manual 2010

March 15, 2012, is also the compliance date for using the 2010 standards. Medicare supplement work group additional comments to naic on the draft revisions to the medicare supplement compliance manual, clarifying the use of the pooling approach used in the manual and how it may interact with loss ratio standards. Medicare doesnt cover other services or tests ordered by a chiropractor, including xrays, massage therapy, and acupuncture. An audit is an evidencebased assessment of a providers compliance with relevant requirements in relation to the payment of a benefit.

This manual contains all the information you will need in your daytoday interaction with hgsadministrators and the medicare part b program. Compliance with medicare rules for inpatientonly procedures is a real challenge for hospitals. February 2, 2010 linda ziegler and dalora schafer cochairs, medicare supplement compliance manual subgroup naic accident and health working group of the life and health. It is a reference tool to provide important information concerning the role of the provider and office staff in the delivery of healthcare to our members and your patients. Act of 2010, physicians who treat medicare and medicaid beneficiaries will be required to. Naic medicare supplement insurance model regulation. The success of compliance efforts depends on each associates dedication to working with us to implement the compliance program. Naic medicare supplement insurance model regulation compliance manual. Report on medicare compliance rmc is the most timely and reliable source of news on medical necessity, inpatient and outpatient billing, stark and antikickback compliance, documentation, claim denials and appeals, medicare advantage and more.

Manuals cms centers for medicare and medicaid services. These regulations adopted revised, enforceable accessibility standards called the 2010 ada standards for accessible design, 2010 standards. Every year billions of dollars are improperly spent. Fqhc status, payment rates, and requirements under titles xviii medicare. The medicare compliance manual is divided into the following sections. Medicare managed care beneficiary grievances, organization determinations, and appeals applicable to medicare advantage plans, cost plans, and health care prepayment plans hcpps, collectively referred to as medicare. Medicare compliance for patient access staff youtube. Medical manager software manual health medicare pdfs. Medicare has prepared this provider manual for our contracted providers. Content focuses on the 7 elements of a comprehensive compliance framework as defined by the health and human services office of the inspector general in its 1999 compliance guidance for hospices. The medicare compliance officer developed this medicare compliance plan in accordance with guidance from applicable state and federal regulations. You can get this document in spanish, or speak with someone.

On april 15, 2010, cms issued a final rule notice in an effort to increase its oversight efforts and ensure that sponsors have effective compliance programs in place. Report on medicare compliance rmc is the most timely and reliable source of news on medical necessity, inpatient and outpatient billing, stark and antikickback compliance, documentation, claim denials and appeals, medicare. Health center program compliance manual introduction bureau of. A complete onsite audit of you office, procedures, policies and records and development of a customized office compliance program manual. In addition, the compliance manual is not intended to address best or promising practices or performance improvement strategies that may support effective operations or organizational. A roadmap for new physicians compliance programs for physicians. Compliance program manual provides a description of these standards and a plan for implementing the compliance program. The goal is to provide a seamless and transparent experience to help you get the information you need to make good health care choices. Compliance programs for physicians physician roadmap. Were improving and modernizing the way you get medicare information.

Jul 14, 2011 february 2, 2010 linda ziegler and dalora schafer cochairs, medicare supplement compliance manual subgroup naic accident and health working group of the life and health actuarial task force. June 1, 2010 as 2010 standardized benefit plans 2010 sb plans. Naic medicare supplement insurance model regulation compliance manual 2010 subject. Medicare managed care manual prescription drug benefit cms. Packaged in a deluxe ring binder with tab indexes, the medicare compliance manual. The code of federal regulations cfr outlines these requirements, and they are defined by cms in the january 11, 20, compliance program guidelines in chapter 21 of the medicare managed care manual and chapter 9 of the prescription drug benefit manual. This manual addresses many of the issues associated with medicare supplement standardization and filing requirements as outlined in the naic model regulation to implement the naic medicare supplement insurance. Rehab compliance experts nancy beckley and associates. In 2003, we transformed the cms program manuals into a web userfriendly presentation and renamed it the cms online manual system. This is the best protection that you can have against medicare. Health center program compliance manual introduction bureau. Meridiancomplete is a health plan that contracts with both medicare and illinois medicaid to provide benefits of both programs to enrollees.

Feb 18, 2011 in auditing sponsors compliance plans, cmpcog audits sponsors implementation of the compliance plan requirements, including a fraud and abuse program for part d. Medicare compliance training handbook debbie mackaman rhia, cpco, ccds tegip compliance with medicare rules for inpatientonly procedures is a real challenge for hospitals. Compliance with changes to medicare supplement rules. The office compliance program medicare for chiropractors.

The medicare compliance manual 2020 is packed with the information you need to maximize your medicare reimbursement and protect yourself from audit liability. Revision july 2010 provider manual chapter 15, page 3 of 9 15. Medicaremedicaid compliance policies and procedures table of contents. The complete guide to medicare secondary payer compliance. Services cms interpretation of the compliance program requirements. This health center program compliance manual compliance manual applies. Health partners plans medicare compliance program applicability at hpp, our program is executed by a dedicated medicare compliance staff and is applicable to the organizations medicare line of business, covering hpps cms medicare advantage and part. The experience of all 1990 standard plans shall be pooled. Cochairs, medicare supplement compliance manual subgroup naic accident and health working group of the life and health actuarial task force subject. Compliance audits and office compliance program development. Along the way well help you with ongoing questions on documentation, coding, and billing as well as the various medicare requirements. Please visit our rehab compliance store, which will continue to be updated with policy manuals and compliance tools. Heres a sampling of how we can help you and your organization.

These included a rationale for admission, the postadmission evaluation as well as individual overall plan of care and a team conference. Supplier compliance with medicare requirements for replacement of positive airway pressure device supplies. Health partners plans medicare compliance program applicability at hpp, our program is executed by a dedicated medicare compliance staff and is applicable to the organizations medicare line of business, covering hpps cms medicare. This includes requirements for implementing medicare part d compliance. On march 15, 2012, compliance with the 2010 standards was required for new construction and alterations under titles ii and iii. The cms 2010 regulations outlined specific technical criteria that apply to all medicare patients admitted to irfs medicare benefit policy manual, 2010.

Chapter 9 of cmss prescription drug benefit manual, provides guidance on the. The medicare claims processing manual the manual, pub. If you think your chiropractor is billing medicare for. Protocols for responding to audits conducted by outside entities is set forth in appendix 2. The medicare improve ment for patients and providers act of 2008 mippa created a new set of standardized plans that differ. With the passage of the patient protection and affordable care act of 2010, physicians who treat medicare and medicaid beneficiaries will be required to establish a compliance program. Medicare quarterly provider compliance newsletter findacode. Medicaremedicaid compliance policies and procedures.

Cms officials stated that although the performance audits conducted in 2010 assessed part d sponsors compliance plans, the audits did so as part of overall assessments of sponsors. Why are hospitals and other providers so highly scrutinized when medicare part d compliance benefits are ripe for enforcement activities. It has all the tools you and your compliance team need to plan and execute a customized compliance program. This manual provides critical information regarding provider and plan responsibilities. Medicare parts c and d general compliance training cms. She has been an invited guest speaker at numerous industry events, for individual and trade organizations, and. The following standards apply to medicare supplement policies and other requirements of this part. The experience of all 1990 standard plans shall be pooled with the experience of all 2010 standard plans of the same letter designation for all rating purposes. Medicare managed care beneficiary grievances, organization determinations, and appeals applicable to medicare advantage plans, cost plans, and health care prepayment plans hcpps, collectively referred to as medicare health plans pdf.

The health care compliance professionals manual is one of the most vital, longstanding, and best known resources in the world of health care compliance. The downloads section of the cms compliance program policy and guidance chapter 9 of the medicare prescription drug benefit manual. We consider this generic version of the medical management manual 2010 edition if the user makes changes of any type health center program compliance manual bureau of primary bphc. Medicare managed care manual prescription drug benefit. This new edition of health care compliance legal issues manual provides a comprehensive overview of the legal issues that create the foundation for healthcare compliance programs, and affect every. The health care compliance professionals manual gives you all the tools you need to plan and execute a customized compliance program that meets federal standards. Health care compliance professionals law manual, 2nd ed. Confirming public agency status under the health center program. Medicare compliance for suppliers unitedhealth group. It is the only hospital compliance manual that is specific to california. All providers billing for any laboratory services must be clia certified and approved. This manual addresses many of the issues associated with medicare supplement standardization and filing requirements as outlined in the naic model regulation to implement the naic medicare supplement insurance minimum standards model act the model regulation.

State law is addressed throughout the manual where applicable. The medicare compliance manual 2006 contains over 900 pages packed with the information you need to maximize your medicare reimbursement and protect yourself from audit liability. As you become familiar with the manual, you will find it is very comprehensive. Registration staff must understand the basics of each medicare rule and how they are used to deliver the necessary paperwork to the patient. Healthcare providers must be completely compliant with all medicare. The purpose of the compliance manual is to provide a consolidated resource to assist health centers in understanding and demonstrating compliance with health center program requirements.

What is happening with the 2010 medicare physician fee schedule. Medicare quarterly provider compliance newslettervolume 1, issue 1 october 2010. In our letter of february 2, 2010, the american academy of actuaries1 medicare. The compliance manual identifies requirements found in the health center. She has become recognized nationally as an expert in medicare secondary payer compliance. Now you can get all the important medicare compliance information you need in a single, easytouse book at a very affordable price. The experience of all 1990 standard plans shall be pooled with the experience of all 2010.

You should evaluate the need for other accident and sickness coverage you have that may duplicate this policy. Draft revisions to the medicare supplement compliance manual dear linda and dalora. February 2, 2010 linda ziegler and dalora schafer cochairs, medicare supplement compliance manual subgroup naic accident and health working group of the life and health actuarial task force. A federal government website managed and paid for by the u. Ahla healthcare compliance legal issues manual ahla members.

Annual subscriptions to the medicare part b reference manual are available. Manual and the most current physicians services provider fee schedule. Hrsa will update or amend the compliance manual as needed to provide further policy clarification with. These compliance program guidelines reflect the centers for medicare and medicaid. Supplier compliance with medicare requirements for. The experience of all 1990 standard plans shall be pooled with the experience of all 2010 standard plans of the same letter designation for all rating. Medicaid provider manual home department of health state of. Available via print or the internet, the manual walks you through the entire process, start to finish, showing you how to draft compliance policies, build a. Medicare rules and regulations 2020 a comprehensive listing of current benefit policies, national coverage determinations, claims processing, medicare. The guidelines offer explanation and amplification on the intent of the medicare hospice regulations. The centers for medicare and medicaid services cms entered into a. The requirement is that every medicare provider create, implement, and maintain a medicare compliance plan that addresses seven specific areas of fraud and abuse prevention. An audit is an evidencebased assessment of a providers compliance.

The compliance manual does not provide guidance on requirements in areas beyond health center program requirements or outside hrsas oversight authority. Oig compliance program guidance for clinical laboratories. Medicare compliance, reimbursement, and payment guides are designed to provide health care professionals with a better understanding of medicare s rules and regulations. This course will prepare you to develop a medicare compliance plan that is. When you subscribe, you will stay up to date on audits. The following information and resources are provided to help keep physical therapists compliant. Chapter 9 compliance program complying with medicare signature requirements cms. Standard medicare supplement benefit plans for 1990 standardized medicare supplement. This article, part 1 of a 2part series, provides an overview of the current medicare compliance climate and its implications for hospice providers. It offers daytoday operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. State of missouri changes to medicare supplement rate filing requirements. Perceptions of inpatient rehabilitation changes after the. The interpretive guidelines are a component of appendix m of the state operations manual. Medicare part b reference manual center for regulatory.