Need help with Medicare payment issues or with Medicare coding? Do you need information about Medicare enrollment or about participation options? Or are you looking for information about the future of Medicare – what about the payment update, new provisions in the federal Affordable Care Act, new bonuses or new compliance requirements?
Although the Sustainable Growth Rate (SGR) formula is now in the history books, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is likely to accelerate the current movement in health care towards value-based payment systems — for all physicians. Sooner rather than later, you will have to prepare to participate in a Merit-Based Incentive Payment System (MIPS) or an alternative payment model system. Doing nothing may cost you. Will doing something (the wrong way) cost you more? TMA can help.
Take advantage of these member benefits: Hassle Factor Log Program, TMA's 30-Minute Billing Cure, and the Coding and Billing Hotline. TMA staff includes expert coders, reimbursement specialists, and other certified professionals to help you.
Do you have questions and need quick answers? Contact Novitas Solutions with questions.(855) 252-8782Mon. - Fri. (8 am - 5 pm)
Use these Novitas website links for quick information:
IVR Flow Guide: Easily navigate Novitas' phone system.
Medical Policy Search: Search by CPT and ICD-9 code or key word.
CMS Fee Schedule
You can also contact the TMA Knowledge Center at (800) 880-7955, or read the latest Medicare E-Tip from TMA.
Medicare fee schedules - Novitas
Physician Fee Schedule Look-Up - CMS
National Physician Fee Schedule Relative Value File: Medicare Fee Schedules
Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedules – CMS
Wellness and Preventive Services
Medicare Preventive Services – CMS
The ABCs of Providing the Initial Preventive Physical Examination - CMS
The ABCs of Providing the Annual Wellness Visit - CMS
Annual Wellness Visit Brochure – CMS
Advanced Diagnostic Imaging – Accreditation Requirements - CMS
Electronic Billing (EDI) Center - Novitas
Claims and Billing Center - Novitas
Advance Beneficiary Notice of Noncoverage - Charging for Services Not Covered by Medicare (PDF) (March 2010)
Payment for Patients Dually-Eligible for Medicare and Medicaid
SE1128 – Prohibition on Balance Billing Qualified Medicare Beneficiaries (QMBs) - CMS
Here’s How You’ll Get Paid for Dual-Eligible Patients (TMA Practice E-Tip)
Provider Enrollment Center – Novitas
Medicare Participating Physician or Supplier Agreement - Novitas
Internet-Based PECOS Enrollment
EDI Enrollment Forms – Novitas
Electronic Funds Transfer (EFT) Authorization Agreement - Novitas
Opting Out of Medicare (Private Contracting) & Current Opt-Out Listing - Novitas
Medicare Enrollment Guidelines for Ordering/Referring Providers (PDF) - CMS
CMS-855B Medicare Enrollment Application (PDF)
How to Complete the CMS-855B Enrollment Application — Tutorial
CMS-855I Medicare Enrollment Application (PDF)
How to Complete the CMS-855I Enrollment Application — Tutorial
CMS-855R Medicare Enrollment Application (PDF)
How to Complete the CMS-855R Enrollment Application — Tutorial
“Medicare Fee-For-Service (FFS) Physicians and Non-Physician Practitioners: Protecting Your Privacy – Protecting Your Medicare Enrollment Record” advises FFS physicians and non-physician practitioners on how to ensure their enrollment records are secure and up-to-date.
“The Basics of Medicare Enrollment for Physicians and Other Part B Suppliers” explains general Medicare enrollment information relevant to physicians and other Part B suppliers.
“The Basics of Internet-Based PECOS for DMEPOS Suppliers” describes general Medicare enrollment information relevant to DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) suppliers.
“The Basics of Medicare Enrollment for Institutional Providers” explains general Medicare enrollment information relevant to institutional providers.
“The Basics of Medicare Enrollment for Physicians Who Infrequently Receive Medicare Reimbursement” describes general Medicare enrollment information relevant to those physicians required to enroll in Medicare for the sole purpose of certifying or ordering services for Medicare beneficiaries.
“The Basics of Internet-Based PECOS for Physicians and Non-Physician Practitioners” provides an overview of how physician and non-physician practitioners can enroll in Medicare using internet-based PECOS.
“The Basics of Internet-Based PECOS for Provider and Supplier Organizations” describes how provider and supplier organizations can enroll in Medicare using internet-based PECOS.
“Internet-Based PECOS Contact Information” provides contact information for technical assistance with internet-based PECOS.
Click here for a complete list of all MLN products related to Medicare provider-supplier enrollment.
Stay Clear of Medicare Fraud Charges
RAC Program Overview – CMS
RAC Program Information – Connolly, Inc.
Provider Options - RAC Overpayment Determination (PDF) – CMS
Recovery-Audit-Program/Downloads/Providers_ADRLimit_Update-03-12.pdf (PDF) – CMS
Are You Checking the OIG Exclusions List?Periodically check the Office of Inspector General (OIG) Individual/Entity Exclusions list. This list should not only be checked prior to employment but also throughout one's employment. No payment should be made by a federal program to an excluded individual.
Office of Inspector General (OIG) Work Plan
Recovery Audit Contractor (RAC) Presentations
Avoiding RAC Audits - On-demand webinar1 AMA PRA Category 1 Credits™ (Enduring)1 ETHICS1 TMLTPresented by: Jonnie Massey, CPC, CPC-P, CPC-I, CPMA in the TMA Education Center
Connolly Consulting, LLC was named Medicare's, Jurisdiction C Recovery Audit Contractor (RAC).Audio File | Slide Presentation | Hand-outs | Connolly Contact Form (PDF)
Presented by: Amy Reese, CMS' RAC contact for Jurisdiction C;Patricia Fenton, RN, BSN, CCM, CMS Nurse Consultant in the Division of Recovery Audit Operations;Christine Castelli, Connolly Consulting's former point-of-contact for Region C RAC program
Healthcare Provider Compliance Training Videos – OIG
10 Things to Know About Medicare Advantage
Medicare Advantage and Part D Rules
CMS Medicare Advantage (MA) / Part D Contract and Enrollment Data
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.
CMS Medicare Managed Care Manual (PDF)
CMS Private Fee-For-Service (PFFS) FAQs (PDF)
Not Contracted With Medicare Advantage? CMS Ends Dispute Resolution
Reimbursement for Vaccines and Vaccine Administration Under Medicare Part D – CMS (MLN Matters)
Help Patients Avoid Medicare Advantage Fraud
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
National Correct Coding Initiative (NCCI) Edits for Physicians
Evaluation & Management Center - Novitas
CMS Incentive Programs
Electronic Health Record (EHR) Incentive Program
EHR Incentive Program Resource Center
CMS EHR Incentive Programs Web page
End Stage Renal Disease (ESRD) Quality Incentive Program (QIP)
ESRD Overview – CMS
Health Professional Shortage Area (HPSA) Bonus Payments
HPSA Bonus Payments Overview – CMS
HPSA Surgical Incentive Payment (HSIP)
HPSAs Eligible for the Medicare Physician Bonus Payment – HRSA
Major Surgical Procedures Furnished in Health Professional Shortage Areas (HPSAs) – CMS (MLN Matters)
Physician Quality Reporting System (PQRS)
PQRS Resource Center
PQRS Overview – CMS
Physician Quality Reporting System – CMS (MLN Fact Sheet)
Primary Care Incentive Payment Program (PCIP)
Incentive Payment Program for Primary Care Services – CMS (MLN Matters)
Eligibility for New Providers Enrolled in Medicare – CMS (MLN Matters)
FAQs on the Primary Care Incentive Payment Program (PCIP) - CMS (MLN Matters)
Medicare Advocacy - See how TMA is working for you on all things Medicare. PECOS Lookup Tool - Use TMA’s free tool to screen physicians from whom you receive order/referrals to make sure they are enrolled in the Medicare program.
MLN Guided Pathways to Medicare Resources (PDF) - Includes updated information on Medicare resources that provide a fundamental overview of the Medicare program. For all Medicare providers
Guided Pathways Intermediate Part B Booklet (PDF) - Includes updated information on Medicare Professional/Practitioner/Supplier Requirements, Coverage and Reimbursement (General Intermediate Level), Coverage and Reimbursement (By Practitioner Type), Coverage and Reimbursement (By Type of Service), Services by Other Practitioners, Services by Suppliers, Coding, Billing and Reimbursement, DMEPOS (Independent Diagnostic Testing Facility), Quality, including; Medicare approved facilities, Medicare health support, PQRI, QIO and quality initiatives.
Medicare Opt-Out Calculator - Use this calculator to determine the net annual financial impact of opting-out of Medicare and compare to the effect the Medicare fee change will have on practice revenues.
Centers for Medicare and Medicaid Services
Novitas Medicare Part B Center
TMA Knowledge Center – Ask TMA
The CMS Quarterly Provider Update