RESOURCES AND CITATIONS - HBMA



RESOURCES AND CITATIONS

OIG Compliance Guidance:



OIG Exclusions:

Federal Register:



Code of Federal Regulations:



Federal Sentencing Guidelines:



OIG Fraud Alerts:

OIG Workplan(s):

OIG Safe Harbors:

OIG Advisory Opinions:

CMS E&M Documentation Guidelines:

Comprehensive Error Rate Testing (CERT):

http:cms.CERT

http:cms.CERT/CR/list.asp

http:cms.MLNProducts/downloads/certfactssheetv1-3.pdf

HIPAA:



CMS INTERNET ONLY MANUALS (IOM)



CMS Reciprocal Billing & Locum Tenen Rules: Internet Only Manuals (IOM), CMS Pub 100-04, Chapter 12, §30.2.10-30.2.11. Paper Manual: Claims Processing Manual §30.60

Shared Visits:

Internet Only Manuals (IOM), CMS Pub 100-04, Chapter 12, §30.6.1. Paper Manual: Pub 14, MCM Part 3, §15501, Transmittal 1832.

IDTF Regulations:

42CFR 410.33

Teaching Physicians:

Internet Only Manuals (IOM), CMS Pub 100-04, Chapter 12, §100.1.8

Consultations:

Internet Only Manuals (IOM), CMS Pub 100-04, Chapter 12, §30.6.1

“Incident to”:

Internet Only Manuals (IOM), CMS Pub 100-02, Chapter 15, §60.1-60.3

CLIA:



Medicaid state fraud statutes:



Medicare national physician fee schedule look-up:



**Includes payment policy indicators

RVU

Modifiers

GPCI

NCCI:



**Includes Manual

Code pairs, including effective dates

Modifier 59 instructions

Medicaid Fraud:

CMIP.asp_ TopOfPage

National and Local Coverage determinations database (NDC and LCD)

overview.asp



Educational Publications and web based training:





Health provider and specialty shortage bonus (HPSA and PSA):



CMS Forms:



Quarterly Provider Updates:



Physician Quality Reporting Initiative (PQRI):



Healthcare provider and specialty shortage areas:





Medicare CPT statistics, including E&M by specialty:



CMS transmittals database:



Enrollment:

http//cms.MedicareProviderSupEnroll/

NPI:

http:cms.NationalProvIdentStand/

RESOURCES TO HELP EVALUATE COMPLIANCE OFFICER KNOWLEDGE AND EXPERTISE

HCCA sample test:

From the home page, choose HCCB Certification and then select practice exam

CMS webbased training modules (multiple tested topics):

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