Medicare

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 the Medicare Reimbursement Manual Chapter 29.

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

Medicare Internet Only Manuals

Main directory for all Medicare Manuals

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:

5010/D.0 Errata requirements and testing schedule can be found here

Contact your MAC for their testing schedule

Have you done the following to be ready for 5010/D.0?

What do you need to have in place to test with your MAC?

Do you know the implications of not being ready?

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.

Staff Contact

Susan Gaines
Director of Community Development & Financial Services
(217) 541-7409
sgaines@iphca.org

Financial Reports

Medicaid

Coming Soon!

Effectively Managing Others: Critical Skills for CHC Managers and Leaders
June 19 - 21, 2013
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Dental Directors Mentoring Program
July 11, 2013
11:30 a.m. -1:00 p.m.
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National Health Center Week
August 11 - 17, 2013
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Medical & Dental Directors Leadership Training
September 6 -7, 2013
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Managed Care Network Strategies Initiative
Wrap-Up Workshop: August 15, 2013
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IPHCA's 2013 Annual Leadership Conference
October 2 - 4, 2013
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Operational Site Visit Training: Prevent Common Findings from Finding Your Organization
Date: To Be Determined
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500 S. Ninth St.
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info@iphca.org
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