Helpful Links

Attention: Access the latest CMS information regarding the status of COVID-19 public health emergency waivers:

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

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.

Association for Clinical Documentation Improvement 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.

 

 

Medicare-Related Sites - General

Provider Center
Add-on Code Edits (NCCI)
Beneficiary Notices Initiative (MOON, IM, ABNs, HINNs)
Biosimilar Biological Products
Clinical Diagnostic Laboratory Fee Schedule - Overview Page
Clinical Diagnostic Laboratory NCD Manual
Clinical Laboratory Improvement Act Licensure
Clinical Laboratory Improvement Amendments (CLIA)
Comprehensive Error Rate Testing Home Page (CERT) - Overview Page
Covid-19 Vaccine and Treatment Information
CMS acronyms
CMS glossary
CMS Regulations and Guidance Page
Contact Information for CMS
Coverage Center
Coverage Database (NCDs, NCAs, LCDs)
Coverage with Evidence Development (CED)
Departmental Appeals Board
DME Center
Drug SAD (Self-Administered Drug) Exclusion List
EHR Incentive Programs
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
Fee-for-Service Frequently Asked Questions
Forms - CMS Downloads
HHS Employee Directory
Laboratory Date of Service
Manuals - Internet Only Manuals
Manuals - Paper Based Manuals
Medically Unlikely Edits Information
Medicare Administrative Contractors (MAC) Jurisdictions
Medicare Advantage Appeal Contractor
Medicare Advantage Out of Network Payment Guide
Medicare Advantage Payment Dispute Resolution Contractor
Medicare Beneficiary Identifier
Medicare Contractor Interactive Map 
Medicare Home Page (Including Payment Systems)
Medicare Overpayments
Medicare Secondary Payer Recovery Contractor (MSPRC)
MLN Connects Provider ENews
MLN Publications
MLN Matters Articles - Overview Page
National Correct Coding Initiative
National Provider Identifier (NPI) - Overview Page
National Provider Identifier (NPI) Enumerator Site
National Provider Identifier (NPI) Registry
Newsroom Center, Press Releases and Fact Sheets 
Office of Medicare Hearings and Appeals
Open Door Forums - Overview Page
Organized Medical Staff Section
Prescription Drug Coverage - General Information
Preventive Services
Procedure Price Lookup
Promoting Interoperability – 2023 Program Requirements Medicare
Prior Authorization for Certain Hospital Outpatient Department Services - HCPCS Codes
Quality Improvement Organizations
Quality Initiatives - General Information
Quarterly Provider Updates- Overview Page
Recovery Audit Program
Regional Office List
Targeted Probe and Educate (TPE)
Taxonomy Codes
Therapy Code List
Therapy Modifiers CQ/CO – Billing Examples
Transmittals and Program Memoranda

 

Medicare-Related Sites - Hospital

Advisory Panel on Hospital Outpatient Payment
APC Offset List
Device Category Codes
Device-Related Procedure Edits
Direct Graduate Medical Education (DGME) Information
Disproportionate Share Hospital (DSH) Information
Hospital-Acquired Conditions (Present on Admission Indicator) - Overview Page
Hospital Center
Hospital Inpatient Quality Reporting Program
Hospital Outpatient Quality Reporting Program
Inpatient Hospital Reviews 
IPPS - FY2023 Final Rule Home Page
IPPS - Home Page
IPPS - Pricer
IPPS - Regulations and Notices
Laboratory Date of Service Policy
MS-DRG Classifications and Medicare Code Editor (MCE) Definitions
National Correct Coding Initiative (NCCI) - Hospital Outpatient PPS
OCE Specifications
OPPS - Addendum A&B
OPPS Home Page
OPPS - Pricer 
OPPS - Regulations and Notices
PEPPER (Program for Evaluating Payment Patterns Electronic Reports)
Prior Authorization
Provider Number Look Up
Psychiatric Facility Inpatient Prospective Payment System
QIO KEPRO Educational Resources
QIO Livanta Provider Resources
QualityNet Main Page
Revenue Code to Cost Center Crosswalk
Three Day Payment Window Information
Value-Based Programs
Wage Index Files

 

Medicare-Related Sites - Physician/Practitioner

Appropriate Use Criteria Program
Care Management Physician Center 
Practice Administration Center
National Correct Coding Initiative - Carrier
Physician Bonus - HPSA
Physician Fee Schedule - Online Lookup
Physician Fee Schedule - Overview Page
Physician Fee Schedule - Relative Value Files
Physician Fee Schedule - Regulations
Quality Payment Program: 2020 Facility-Based Status
Telehealth
Quality Payment Program for Physicians

Medicare-Related Sites - Post-Acute Care

SNF Center
MDS Manuals and Forms
Nursing Home Quality Initiatives - Overview Page
SNF Consolidated Billing - Overview Page
SNF Regulations
SNF PPS - Overview Page
CMS Skilled Nursing Facility Center Page
MDS 3.0 RAI Manual
SNF Consolidated Billing
List of SNF Federal Regulations
Skilled Nursing Facility PPS
Swing Bed Providers
MDS 3.0 RAI Manual
PAC Quality Initiatives
Hospice Quality Reporting
Home Health PPS
CMS Hospice Page
Home Health Coding and Billing Information

Medicare-Related Sites - Rural Health 

CMS Rural Health Strategy
Critical Access Hospitals (CAH) Center
Federally Qualified Health Centers (FQHC) Center
Rural Health Clinics (RHC) Center

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
Claims Status Request and Response Code Sets
CLIA certificates
CMS Price Transparency FAQs – Initial
CMS Price Transparency FAQs – Additional
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
Index of Quarterly Medicare Compliance Newsletters
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
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

Railroad Medicare

Palmetto GBA Railroad Medicare Information
Railroad Retirement Board

OIG Sites

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

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
Open Congress
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

Miscellaneous

National Technical Information Service (NTIS)