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 Acronyms
CMS Contact Information
CMS General Provider Information
CMS Glossary
CMS Home Page
CMS Manuals - Internet Only
CMS Manuals - Paper Based
CMS Medicare Payment Systems
CMS MLN Publications
CMS MLN Weekly Newsletter
CMS Regional Office List
CMS Transmittals, MLN Articles, and Program Memoranda

Accountable Care Organizations (ACOs): General Information
Accreditation Organizations/Exempt States
Ambulatory Surgical Center (ASC) Quarterly Addenda
Ambulatory Surgical Center (ASC) Regulations and Notices
Appeals - Departmental Appeals Board
Appeals - Office of Medicare Hearings and Appeals
Appeals - Parts A & B Appeals Process MLN
Appropriate Use Criteria Program
Approved IDE Studies
Audiology Services
Beneficiary Notices Initiative (MOON, IM, ABNs, HINNs)
Clinical Diagnostic Laboratory Fee Schedule
Clinical Diagnostic Laboratory NCD Manual
Compliance Tips for Medicare Provider
Comprehensive Error Rate Testing (CERT) Program
Coverage Center
Coverage Database (NCDs, NCAs, LCDs)
Coverage Database How To MLN
Coverage with Evidence Development (CED)
Coverage - Non-covered Services MLN
Covid-19 Vaccine and Treatment Information
Covid-19 Waivers and Flexibilities Fact Sheets
Current public health emergencies
Dental Coverage
DME Center
DMEPOS Fee Schedule
Drug Billing Resources
Drugs - Discarded Drugs and JW/JZ Modifier FAQs
Drugs - Erythropoietin Stimulating Agent Policies
Drugs - Prescription Drug Coverage - General Information
Drugs - Self-Administered Drug Handout
Eligibility and Enrollment for Part A & B
End Stage Renal Disease (ESRD) Consolidated Billing
End Stage Renal Disease (ESRD) Prospective Payment Overview
End Stage Renal Disease (ESRD) Provider Center
Enrollment (Provider and Supplier) - Overview Page
Enrollment Applications
Enrollment - Provider Enrollment, Chain and Ownership System (PECOS)
Enrollment Resources
esMD Electronic Submission of Medical Documentation
Forms - CMS Downloads
Investigational Device Exemption Approved Studies
Investigational Device Exemption Coverage Information
HHS Employee Directory
Medicare Administrative Contractor (MAC) Interactive Map
Medicare Administrative Contractor (MAC) Jurisdictions
Medicare Beneficiary Identifier
Medicare Overpayments MLN Fact Sheet
Medicare Secondary Payer (MSP)
Medicare Secondary Payer (MSP) MLN Booklet
Medicare Secondary Payer Recovery Contractor (MSPRC)
National Plan and Provider Enumeration System
National Provider Identifier (NPI)Information
National Provider Identifier (NPI) Registry
NCCI Medicare Main Page
NCCI Medicare Manual
NCCI Medicare How To Booklet
NCCI Medicare Add-on Code Edits
NCCI Medicare MUE Edits
NCCI Medicare PTP Edits
Newsroom - Press Releases, Fact Sheets, and News Alerts
Open Door Forums - Overview Page
Preventive and Screening Services
Procedure Price Lookup - Hospital Outpatient vs ASC
Promoting Interoperability Program (formerly EHR Incentive Program)
Promoting Interoperability Program - 2024 Program Requirements Medicare
Qualified Medicare Beneficiary (QMB)
Quality Improvement Organizations
Quality Initiatives - General Information
QualityNet Main Page
Recovery Audit Program
Railroad Medicare Information - Palmetto GBA
Railroad Medicare - Railroad Retirement Board
Survey and Certification Information
Targeted Probe and Educate (TPE)
Telehealth Services MLN
Therapy Code List
Therapy FAQs for Individual and Group Treatment
Therapy Modifiers CQ/CO – Billing Examples
Therapy Services
Value-Based Programs

 

Medicare-Related Sites - Advantage Plans

Medicare Advantage Plan General Information
Medicare Advantage Appeal Contractor - Maximus
Medicare Advantage Appeals Guidance
Medicare Advantage Coverage FAQs
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-Related Sites - Hospital

Hospital Center
Advisory Panel on Hospital Outpatient Payment
Direct Graduate Medical Education (DGME) Information
Disproportionate Share Hospital (DSH) Information
Emergency Department and Critical Care FAQs
Hospital-Acquired Conditions (Present on Admission Indicator)
Hospital Inpatient Quality Reporting Program
Hospital Outpatient Quality Reporting Program
Indirect Medical Education (IME)
Inpatient Hospital Reviews 
IPPS - FY2025 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
OCE Quarterly Files - Specifications and Report Tables
OPPS - Addendum A&B
OPPS - CY2024 Final Rule Home Page
OPPS - Home Page
OPPS - Pass-through Device Offset Code Pair List
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 Acentra 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
Physician Medicare Billing: 837P & Form CMS-1500
Quality Payment Program for Physicians
Quality Payment Program: 2024 Facility-Based Quick Start Guide
Quality Payment Program MACRA Page
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

 

Office of Inspector General (OIG) Sites

OIG Home Page
OIG Adverse Events
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

 

Revenue Integrity and Chargemaster Related Sites

Accreditation Standards Committee X12 External Code Lists
Administrative Simplification
Administrative Simplification - Enforcement
Adverse Events OIG Featured Topic
Affordable Care Act (ACA)
Affordable Care Act (ACA) Example Benefit Summary
Affordable Care Act (ACA) Mental Health & Substance Abuse Coverage
Affordable Care Act (ACA) Preventive Services for Adults
Affordable Care Act (ACA) Required Benefits
Biosimilar Biological Products (FDA)
Center for Consumer Information and Insurance Oversight
Claim Adjustment Reason Codes
Claims Status Request (276) and Response (277) Information
Clinical Laboratory Improvement Amendments (CLIA)
CLIA Categorization of Tests, including Test Complexity Database
CLIA Certificate Application
Clinical Trial, CED, IDE Coverage and Billing, Noridian
COBRA and the ACA Insurance Marketplace
Designated Standard Maintenance Organizations (DSMOs)
Electronic Billing and EDI Transactions
Electronic Data Interchange (EDI) Support
FDA-Approved Drug Products
HCPCS General Information
Health Level Seven (HL7)
Healthcare Payment and Remittance Advice Codes
Health Insurance Terms Glossary
HIPAA Eligibility Transaction System (HETS)
IRS Health Savings Accounts Information
IRS Requirements for Non-Profit Hospitals
Medicaid At-a-glance
Medicaid Eligibility
Medicaid Mandatory and Optional Benefits
Medicaid NCCI Edits Main Page
Medicaid State Plan Amendments
Medicare/Medicaid Cross-Over Rejections
Medicare Coordination of Benefits and Recovery Center Overview
Medicare Electronic Funds Transfer Information
Medicare Supplement Insurance (Medigap)
National Healthcare Billing Audit Guidelines
National Institutes of Health Never Event Article
National Plan and Provider Enumeration System (NPPES)
National Provider Identifier (NPI) Downloadable Files
National Provider Identifier (NPI) Registry Search
National Quality Forum Serious Reportable Events
National Uniform Billing Committee (NUBC)
National Uniform Claims Committee (NUCC)
NUBC Official UB-04 Data Specifications Manual
NUCC 1500 Instruction Manual
Organized Medical Staff Section of the AMA
Price Transparency FAQs
Price Transparency Resources
Provider Preventable Conditions
Red Cross Hospital Partner Resource Guide
Red Cross Educational Resources
Remittance Advice Remark Codes
Scope of Practice, Advance Practice Nurse
Taxonomy Code Set
Taxonomy Medicare Information
Workers Compensation Resources
Workers Compensation State Contact Map
WPC EDI Standards(To Access Implementation Guides for the Transaction Standards)

 

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)

 

Listserv Subscriptions

CMS Email Update Lists - Subscriber's Main Page
GPO Listserv - Daily Federal Register (Join FEDREGTOC-L)
Livanta Claims Review Advisors
MLN Connects Newsletters
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 Quarterly Update
ICD-10 Addenda and Guidelines
ICD-10 CMS Home Page
ICD-10-CM/PCS MS-DRG Definitions Manual
ICD-11 Implementation Memo by National Committee on Vital and Health Statistics
JustCoding.com
Merck Manual Online