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Medicare

Articles | Audit and Enforcement | Coding | E-Tips| J4 Transition | Medicare Advantage Plans | Medicare Enrollment| Payment| PQRI| Physician Relations | Links

Medicare Inquiries

Do you have general questions and need quick answers? You can now e-mail Medicare at: partbtx@trailblazerhealth.com. You can inquire about:

• Specific guidelines
• What additional information is needed on a claim
• Medicare Remittance Notice
• CMS rulings
• Where to find procedure allowables

TrailBlazer cannot respond to "patient specific" or protected health information, appeals, or MSP inquires via e-mail.

Articles

• CMS Changes PQRI, e-Prescribing Programs (Action, Nov. 16, 2009) New
• CMS Moves Ahead with Medicare Fee Cut (Action, Nov. 16, 2009) New
• Medicare Begins 2008 PQRI Payments (Action, Oct. 15, 2009) New
• Medicaid, Medicare to Reimburse for H1N1 (Action, Oct. 15, 2009) New
• CMS Issues New Medicare Marketing Rules (Action, Oct. 2, 2009)
• Free PQRI Webinar Coming from TMA, TrailBlazer (Action, July 15, 2009)
• Medicare Scam Alert! (Action, July 15, 2009)
• CMS Posts PQRI Resources (Action, June 16, 2009)
• TMA Weighs in on Weighty Issues (Action, Apr. 1, 2009)
• CMS Orders Ownership Disclosure (Action, Apr. 1, 2009)
• RACs Recoupment Wrong, TMA Says (Action, Mar. 2, 2009)
• RACs Back On (Action, Feb. 16, 2009) 
• A Bundle of Joy from CMS (Action, Jan. 16, 2009)
• CMS Surveying Medicare Contractors (Action, Jan. 5, 2009)
• It's Decision Time on Medicare Participation (Action, Dec. 15, 2008)
• TMA Practice E-Tips Greatest Hits, Vol. 4: All About Medicare 
• AMA Offers PQRI Help, Too (Action, Jan. 16, 2009)
• Receive Your PQRI Incentive Using DocSite (Action, Dec. 1, 2008)
• CMS Puts RACs on the Shelf (Action, Nov. 17, 2008)
• TMA to CMS: Reform the GPCIs (Action, Nov. 17, 2008)
• CMS Schedules PQRI Call (Action, Nov. 17, 2008)
• CMS Cracks Down on Medicare Abuse  (Action, Oct. 15, 2008)
• CMS Puts Drug Information Online  (Action, Oct. 15, 2008)
• CMS Revises RAC Rollout Timeline (Action, Oct. 1, 2008)
• Medicare's Competitive Acquisition Program Delayed (Action, Oct. 1, 2008)
• How TMF Does Reviews (Action, Oct. 1, 2008)
• Medicare Providers OK with New MACs (Action, Sept. 15, 2008)
• CMS Examines Payment Localities (Action, Sept. 2, 2008)
• Use DocSite to Earn a Medicare Bonus (Action, Sept. 2, 2008)
• CMS Posts PQRI Feedback Reports (Action, Sept. 2, 2008)
• 2008 Medicare Physician Fee Schedule 
• Medicare Bill Includes e-Prescribing Incentives (Action, Aug. 18, 2008)
• CMS Won't Accept Signature Stamps (Action, Aug. 18, 2008)
• Medicare Expands No-Pay List (Action, Aug. 18, 2008)
• TrailBlazer Using New Medicare Fee Schedule (Action, Aug. 1, 2008)
• Medicare Prescription Rules to Change (Action, July 1, 2008)
• Senate Betrays Medicare Patients, Physicians (Action, July 1, 2008)
• CMS to Hold Medicare Claims (Action, July 1, 2008)
• CMS Names DMEPOS Metroplex Ombudsman (Action, July 1, 2008)
• Lawsuits Challenge New DMEPOS Rules (Action, June 16, 2008)
• Congress Still Working on Medicare Fees (Action, June 16, 2008)
• Cornyn Files Medicare Reform Bill  (Action, March 17, 2008) 

Audit and Enforcement

• Avoid These Top 10 Medicare Billing Errors
• CMS to Delay Part of Stark III  (Action, Nov. 15, 2007)
• Office of Inspector General Fraud and Abuse Work Plan

Medicare Recovery Audit Contractors

Coding

• E&M Service Utilization Statistics 
• TrailBlazer Sends E&M Education Letters to Texas Physicians
• Correct Coding Initiative (CCI) Edits
• Medicare Claims Must Have Diagnosis Codes
• Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
• Medicare Part B Newsletter Index

J4 Transition 

• What you need to know  (TrailBlazer)
• J4 News  (TrailBlazer)
• J4 FAQs  (TrailBlazer)
• J4 Resources  (TrailBlazer)

Medicare Advantage Plans

• 10 Things to Know About Medicare Advantage
• Medicare Advantage and Part D Rules 
• Don't Increase Medicare Advantage Plans' Fees (Action, Apr. 15, 2008)  
• TDI Bans Temporary Agents (Action, Dec. 15, 2007) 
• Help Patients Avoid Medicare Advantage Fraud  (Action, Nov. 15, 2007)
• New AMA resources explain Medicare Advantage plans (Some tools are for AMA members only)
• CMS Approved Medicare Advantage Plans - Identify the HMO, PPO, SNP, MSA, PFFS health plans available in your area. The data can be sorted by state, county, insurer name, plan name, or by type of health plan offered. These plans became effective beginning January 1, 2007.
• CMS Medicare Advantage (MA) / Part D Contract and Enrollment Data
• CMS Medicare Managed Care Manual (PDF)
• CMS Private Fee-For-Service (PFFS) FAQs (PDF)
• Aetna Medicare Private Fee-For-Service (PFFS) Plan
• Uniform card for ALL UniCare Medicare Advantage Plans (PDF)

Medicare Enrollment

• CMS-855B Medicare Enrollment Application (PDF)
• How to Complete the CMS-855B Enrollment Application — Presentation (PDF )
• CMS-855B New Application Process (PDF) - TrailBlazer
• CMS-855B Application for Change of Information Process (PDF) - TrailBlazer
• CMS-855 NPI Error Resolution Process (PDF) - TrailBlazer
• CMS-855I Medicare Enrollment Application (PDF)
• How to Complete the CMS-855I Enrollment Application — Presentation (PDF)
• CMS-855R Medicare Enrollment Application (PDF)
• How to Complete the CMS-855R Enrollment Application — Presentation (PDF)
• Internet-Based PECOS Enrollment  
• CMS Revises Medicare Enrollment Application (Action, Apr. 15, 2008) 
• EDI Enrollment - TrailBlazer
• Electronic Funds Transfer (EFT) Information - TrailBlazer
• Medicare Opt-Out Affidavit  (PDF) - TrailBlazer    
• Will You Participate?  (Action, Dec. 1, 2008)
• Par Enrollment - TrailBlazer
• Facilitating Your Medicare Enrollment (PDF)
• Updated Medicare Provider Enrollment Information
• Application Guide for Medicare Enrollment With Form 855I (PDF)  

Payment

• Message for Providers/Suppliers Concerning CR 6421
• Message for Providers/Suppliers Concerning CR 6417 
• CMS to Hold Medicare Claims (Action, July 1, 2008)
• CMS Revises ABN Form (Action, Apr. 1, 2008)
• Medicare Fees: Stand Up and Be Counted (Action, Feb. 1, 2008)
• TMA Begins New Phase of Medicare Fee Battle (Action, Jan. 15, 2008)
• CMS Delays 'Anti-Markup' Rule (Action, Jan. 15, 2008)
• Act Now or Live With the Medicare Fee Cut  (Action, Dec. 1, 2007)
• Medicare Plans Another 'Negative Update'  (Action, Nov. 15, 2007)
• Medicare Payments to Speed Up, Stop, then Return to Normal 
• Medicare fee schedules - by geographic region  - TrailBlazer
• Physician Billing Requirements for Skilled Nursing Facility (SNF) Consolidated Billing (PDF)
• Drug Coverage Guidelines 
• Final Rule for Electronic Submission of Medicare Claims (PDF, August 2003)

Physician Quality Reporting Initiative (PQRI)

• CMS Posts PQRI Resources (Action, June 16, 2009)
• PQRI Resource Center
• Receive Your PQRI Incentive Using DocSite (Action, Dec. 1, 2008)
• CMS Posts PQRI Feedback Reports (Action, Sept. 2, 2008)
• Use DocSite to Earn a Medicare Bonus (Action, Sept. 2, 2008)  

Physician Relations

• Government Makes Leniency Available for Self-Referral and Antikickback Self-Disclosure (PDF )
• Medicare to Get Tough on Physician Applications, Again
• TrailBlazer Health Enterprises, LLC Medicare Part B Texas Contacts (PDF)
• TrailBlazer Medicare Part B: Problem Solving Guide for Texas Physicians/Providers (PDF)

Links

• New CMS Web site for MA/Part D Contract and Enrollment Data 
• Medicare Part D
• Reimbursement for Vaccines and Vaccine Administration under Medicare Part D (PDF)
• The CMS Quarterly Provider Update
• Centers for Medicare and Medicaid Services
• National Physician Fee Schedule Relative Value File: Medicare Fee Schedules
• TMA Communities (online networks for connecting with other physicians, practice managers, and staff)
• TMA Knowledge Center
• TrailBlazer Health
• Enterprises
• CMS Hurricane Katrina Web site
• TrailBlazer Part B Medicare Provider
• Enrollment

Last Published: 11/20/2009