Helpful Links

Compiled by HCPro regulatory specialists, the following is a collection of helpful links for healthcare professionals researching coding, billing, compliance and Medicare questions. Set this page as your homepage for a convenient shortcut to valuable research tools.

Index

 

 

HCPro Websites

Association for Clinical Documentation Integrity Specialists (ACDIS)  - The membership association especially for CDI professionals. Access industry experts and peers across the nation, and learn CDI resources for development including the CCDS credential for CDI professionals.

JustCoding.com - JustCoding.com web-based libraries and resources will prepare you for current and future coding changes and provide CE credits to keep your skills sharp.

National Association of Healthcare Revenue Integrity (NAHRI) - NAHRI's mission is to enhance the revenue integrity profession through standards, advocacy, networking, and the promotion of shared knowledge and resources.

 

Medicare-Related Sites - General

CMS Home Page
CMS General Provider Information
Ambulatory Surgical Center Quarterly Addenda
Ambulatory Surgical Center Regulations and Notices
Appropriate Use Criteria Program
Beneficiary Notices Initiative (MOON, IM, ABNs, HINNs)
Clinical Diagnostic Laboratory Fee Schedule
Clinical Diagnostic Laboratory NCD Manual
Clinical Laboratory Improvement Amendments (CLIA)
Comprehensive Error Rate Testing (CERT) Program
Covid-19 Vaccine and Treatment Information
Covid-19 Waivers and Flexibilities Fact Sheets
CMS acronyms
CMS glossary
Compliance Tips for Medicare Provider
Contact Information for CMS
Coverage Center
Coverage Database (NCDs, NCAs, LCDs)
Coverage with Evidence Development (CED)
Current public health emergencies
Departmental Appeals Board
DME Center
End Stage Renal Disease (ESRD) Consolidated Billing
End Stage Renal Disease (ESRD) Provider Center
Enrollment (Provider and Supplier) - Overview Page
esMD Electronic Submission of Medical Documentation
FDA-Approved Drug Products
Forms - CMS Downloads
HHS Employee Directory
Laboratory Date of Service Policy
Manuals - Internet Only Manuals
Manuals - Paper Based Manuals
Medicare Administrative Contractors (MAC) Jurisdictions
Medicare Advantage Appeal Contractor - Maximus
Medicare Advantage Appeals Guidance
Medicare Advantage Out of Network Payment Guide
Medicare Advantage Payment Dispute Resolution for Non-Contracted Providers
Medicare Advantage Value Based Insurance Design - Hospice Model
Medicare Beneficiary Identifier
Medicare Contractor Interactive Map
Medicare Overpayments MLN Fact Sheet
Medicare Secondary Payer Recovery Contractor (MSPRC)
MLN Connects Newsletters
MLN Publications
MLN Matters Articles - Special Edition and Transmittal Related - All Years
National Plan and Provider Enumeration System
National Provider Identifier (NPI)Information
National Provider Identifier (NPI) Registry
NCCI Medicare Main Page
NCCI Medicare Manual
NCCI Medicaid Main Page
NCCI - Add-on Code Edits
NCCI - Medically Unlikely Edits
NCCI - Procedure to Procedure Edits
Newsroom - Press Releases, Fact Sheets, and News Alerts
Office of Medicare Hearings and Appeals
Open Door Forums - Overview Page
Organized Medical Staff Section of the AMA
Prescription Drug Coverage - General Information
Preventive and Screening Services
Procedure Price Lookup - Hospital Outpatient vs ASC
Promoting Interoperability Program (formerly EHR Incentive Program)
Promoting Interoperability Program - 2023 Program Requirements Medicare
Quality Improvement Organizations
Quality Initiatives - General Information
QualityNet Main Page
Recovery Audit Program
Railroad Medicare Information - Palmetto GBA
Railroad Medicare - Railroad Retirement Board
Regional Office List
Self-Administered Drug Handout
Targeted Probe and Educate (TPE)
Taxonomy Codes
Therapy Code List
Therapy Modifiers CQ/CO – Billing Examples
Transmittals and Program Memoranda
Value-Based Programs

 

Medicare-Related Sites - Hospital

Hospital Center
Advisory Panel on Hospital Outpatient Payment
Annual Policy Files 2023 - APC Offset List
Direct Graduate Medical Education (DGME) Information
Disproportionate Share Hospital (DSH) Information
Hospital-Acquired Conditions (Present on Admission Indicator)
Hospital Inpatient Quality Reporting Program
Hospital Outpatient Quality Reporting Program
Inpatient Hospital Reviews 
IPPS - FY2024 Final Rule Home Page
IPPS - Home Page
IPPS - Pricer
IPPS - Regulations and Notices
MS-DRG Classifications and Medicare Code Editor (MCE) Definitions
OCE Quarterly Files - Specifications and Report Tables
OPPS - Addendum A&B
OPPS Home Page
OPPS - Regulations and Notices
Prior Authorization for Hospital Outpatient Procedures
PEPPER (Program for Evaluating Payment Patterns Electronic Reports)
Provider Data Files - Provider Number Look Up
Psychiatric Facility Inpatient Prospective Payment System
QIO KEPRO Educational Resources
QIO Livanta Provider Resources
Revenue Code to Cost Center Crosswalk
Three Day Payment Window Information
Wage Index Files

 

Medicare-Related Sites - Physician/Practitioner

Physician Center 
Practice Administration Center
Care Management
Health Professional Shortage Area (HPSA) Bonus Information
Physician Fee Schedule - Online Lookup
Physician Fee Schedule - Overview Page
Physician Fee Schedule - Relative Value Files
Physician Fee Schedule - Regulations
Quality Payment Program for Physicians
Quality Payment Program: 2020 Facility-Based Status
Telehealth Overview Page
Telehealth Services List and Originating Site Fees

 

Medicare-Related Sites - Post-Acute Care

Skilled Nursing Facility (SNF) Center
Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual
Nursing Home Quality Initiatives
SNF Consolidated Billing Information
SNF Consolidated Billing Files
SNF PPS Home Page
SNF Quality Reporting Program (QRP)
SNF Regulations
Swing Bed Providers

Home Health Agency Center
Home Health Consolidated Billing File
Home Health Patient-Driven Groupings Model (PDGM) Information
Home Health PPS
Home Health PPS Grouper Software
Home Health Quality Reporting Program
Home Health Regulations and Notices

Hospice Center
Hospice Coverage
Hospice Educational Resources
Hospice Quality Reporting Program
Hospice Regulations and Notices

 

Medicare-Related Sites - Rural Health

CMS Health Equity - Rural Health
CMS Regional Office Rural Health Coordinators
Rural Providers & Suppliers Billing MLN Booklet

Critical Access Hospitals (CAH) Center
CAH and Swing Bed Survey Protocols and CoP Interpretive Guidelines
CAH MLN Booklet

Rural Health Clinics (RHC) Center
RHC Regional Office Survey and Certification Contacts
RHC Survey Protocols and CfC Interpretive Guidelines

 

Medicare-Related Sites - Federally Qualified Health Centers

Federally Qualified Health Centers (FQHC) Center
Grandfathered Tribal FQHCs

 

Revenue Integrity and Chargemaster Boot Camp Links

837 Format
ACA Benefit Summary Example
Accountable Care Organizations
Accreditation Organizations
Administrative Simplification
Adverse Event Information from the OIG
Affordable Care Act (ACA) Information
Affordable Care Act Required Benefits
Appropriate Use Criteria
Article Regarding the Relationship Between Charges and Payments
Audiology Services
Balance Billing
Behavioral Health Benefits under ACA
Billing for Non-Covered Services/BCBS
California Proposed Legislation Limiting Charges
Categorization of Tests
Center for Consumer Information and Insurance Oversight - Regulations and Guidance
Claims Status Request and Response Code Sets
CLIA certificates
CMS Price Transparency FAQs
CMS Price Transparency Resources
COBRA and the Insurance Marketplace
Coverage with Evidence Development
Designated Standard Maintenance Organization (DSMO)
Device Category C-Codes
DMEPOS Fee Schedule
Drug Coverage Under Parts A, B and D/a>
Electronic Billing and EDI Transactions
Electronic Claims Attachments
Enrollment Resources
Erythropoietin Stimulating Agent Policies
ESRD Consolidating Billing
ESRD Prospective Payment Overview
HCPCS General Information
Healthcare Payment and Remittance Advice Codes
Health Insurance Terms Glossary
Health Maintenance Organizations
Health Savings Account IRS site
HIPAA Eligibility Transaction System (HETS)
Hospital Acquired Conditions (HACs)
Hospital Acquired Condition ICD-10 Code List
How Insurance Works
How to Use the Medicare Coverage Database
ICD Registry
Investigational Device Exemption - Medicare Information
IRS Requirements for Non-Profit Hospitals
Major Joint Procedures
Managed Care Contracting Terms
Medicare Advantage Coverage
Medicare Advantage Provider Payment Dispute Resolution
Medicaid Eligibility
Medicare/Medicaid Cross-Over Rejections
Medicare Appeals Process
Medicare Coordination of Benefits and Recovery Center Overview
Medicare Electronic Funds Transfer Information
Medicare Part A and B Eligibility and Enrollment
Medicare Non-covered Services
Medicare Secondary Payer
Medicare Secondary Payer Booklet
Medicare Secondary Payer Information
Medicare Secondary Payer Manual
Medicare Secondary Payer Fact Sheet
Medicare Supplement Insurance (Medigap)
Medicare Survey and Certification Process
Medicare Telehealth Services
MedPAC Payment Basics
Merit-Based Incentive Payment System (MIPS)
MLN Provider Compliance Newsletters
National Healthcare Billing Audit Guidelines
National Institutes of Health Never Event Article
National Quality Forum Serious Reportable Events
National Uniform Billing Committee (NUBC)
National Uniform Claims Committee (NUCC)
OPPS Claims Accounting Document
OPPS Visit Code FAQs
Preferred Provider Organization
Preventive Services for Adults under ACA
Provider Enrollment
Provider Enrollment, Chain and Ownership System (PECOS)
Provider Preventable Conditions
Provider Reimbursement Manual
PT and OT Billing Scenarios
Qualified Medicare Beneficiary (QMB)
Railroad Medicare
Reassignment of benefits
Red Cross Information on Coding, Coverage and Reimbursement of Blood
Scope of Practice, Advance Practice Nurse, Oregon Board of Nursing
Supplier Assignment
Targeted Probe and Educate Program
Therapy Services
Transparency and Disclosure of Health Care Costs and Provider Payments Summary
Value-Based Programs
Workers Compensation Information

 

OIG Sites

OIG Home Page
OIG Compliance Information Page
OIG Health Care Fraud Prevention and Enforcement Action Team (HEAT)
OIG Special Fraud Alerts, Bulletins and Guidance
OIG Work Plan Information

 

Regulations and Statutes

CFR Title 42 - Electronic Version
Code of Federal Regulations (Federal Regulations Annual Edition)
Congress.gov
Federal Register
GPO FDSys (Federal Digital System) Home Page
Social Security Act, Title 18 (Medicare)
United States Code (Federal Statutes)

 

HIPAA Transaction and Code Set Standards

National Uniform Billing Committee (NUBC)
National Uniform Claim Committee (NUCC)
Official UB-04 Data Specifications Manual
WPC EDI Standards(To Access Implementation Guides for the Transaction Standards)

 

Listserv Subscriptions

CMS Email Update Lists - Subscriber's Main Page
GPO Listserv - Daily Federal Register (Join FEDREGTOC-L)
Livanta Claims Review Advisors
NIH Listserv Homepage
OIG List Serv
HCPro Free Email Newsletters

 

Coding and Clinical Resources

AHA Coding Clinic for HCPCS Ordering Information
ICD-10 Coding Clinic
American Academy of Professional Coders
American Health Information Management Association
American Hospital Association Central Office
CPT Assistant Ordering Information
CPT Manual Errata
HCPCS Data File
HCPCS Quarterly Update
ICD-10 Addenda and Guidelines
ICD-10 CMS Home Page
ICD-10-CM/PCS MS-DRG Definitions Manual
JustCoding.com
Merck Manual Online