Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria.
Medicare Learning Network (MLN)
Medicare articles called MLN Matters are produced by CMS and explain policy and procedures. See the archive for all published MLN Articles.
National Government Services (NGS)
NGS is a processor of Medicare claims for Illinois FQHCs. The NGS Website for FQHCs contains provider notices, production alerts for electronic claims systems, appeals process, training manuals, workshops, and webinars.
Medicare Cost Report
All providers required to file a Medicare cost report are required to submit their cost report within five months of the cost reporting fiscal year end, or 30 days after a valid provider statistical and reimbursement (PS&R) report is sent to the provider by National Government Services—whichever is later. Information about the report is available on the NGS audit and reimbursement webpage. Instructions for the Medicare cost report are available on the CMS paper based manuals website. Use Chapter 29 of Publication 15-2.
Medicare Benefit Policy Manual
Chapter 13 describes the Medicare services and providers specific to FQHCs.
Chapter 15 includes covered medical and other health benefit services for eligible beneficiaries. This is useful when dealing with Part B services.
Medicare Claims Processing Manual
Chapter 1 includes general billing requirements such as provider assignment to FIs and MACs, provider participation, etc.
Chapter 9 details FQHC policies, payment methodology, allowable costs, annual cost report reconciliation, etc.
Chapter 18 indicates coding and payment for preventive and screening services.
Chapter 25 defines the CMS-1450 data set (UB-04) data elements
ICD-10-CM Transition
Information on the ICD-10-CM transition includes resources and timelines. The transition is required to be complete for dates of service on or before October 1, 2013.
HIPAA 5010/D.0 Implementation
January 1, 2011 marked the beginning of the 5010/D.0 transition year. The following are links to reminders and readiness assessments:
Technical Assistance
IPHCA staff is able to assist members with questions regarding Medicare billing, cost reporting and rates. Contact Susan Gaines at (217) 541-7409 or sgaines@iphca.org.