DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid Services

Medicare Learning Network® (MLN) Suite of Products & Resources for Compliance Officers

ICN 908525 August 2016

What’s Inside the Suite?

Find online resources that provide guidance to educate and address the many compliance issues facing providers today.

How Will the Suite Help Me?

MLN products can enhance and strengthen your knowledge of general compliance guidelines, the claims submission process, as well as supporting your understanding of initiatives and incentives. Save this suite to use as a reference!

Start Learning Now

Click on any of the resources to view the product. You can download information, listen to a podcast, explore an article through MLN Matters®, or even sign up for a Web-Based Training (WBT) course–many of which offer continuing education credits.

Bookmark These Quick References

MLN HomepageThe MLN is your home for Centers for Medicare & Medicaid Services (CMS) education, information, and resources for the health care professional community.

Medicare Benefit Policy ManualThe Medicare Benefit Policy Manual describes general Medicare coverage instructions.

Medicare Claims Processing ManualThe Medicare Claims Processing Manual contains billing requirements, rules,and regulations.

Medicare Coverage Database (MCD)The MCD contains national and local Medicarecoverage determinations, analyses, proposed decisions, coding analyses, and other information. Use this how-to guide to access information about the MCD.

National Correct Coding Initiative (NCCI)Learn how to navigate the CMS NCCI website with this helpful booklet. The NCCI helps reduce coding and billing errors.

Medicare Learning Network® (MLN) Suite of Products & Resources for Compliance Officers

SELECT A TOPIC FOR MORE INFORMATION

General Compliance ResourcesThe MLN Provider Compliance Web Page contains educational products that inform Medicare health care professionals about how to avoid common billing errors and other improper activities when dealing with the Medicare Program.

The Medicare Claim Review Programs publication provides an overview of the various Medicare claim review programs.

The Medicare Quarterly Provider Compliance Newsletter Archive provides education about common billing errors and other claim review findings identified by Medicare Administrative Contractors (MACs), Recovery Auditors, Program Safeguard Contractors, Zone Program Integrity Contractors, the Comprehensive Error Rate Testing (CERT) review contractor and other organizations, such as the Office of Inspector General.

MLN Matters Articles are national articles designed to inform Medicare health care compliance professionals about the latest changes to the Medicare Program.

Comprehensive Error Rate Testing (CERT) Reports include the annual Improper Medicare Fee-For-Service Payment rate.

The Review Contractor Directory — Interactive Map allows you to access State-specific CMS contractor contact information.

SELECT A RESOURCE BY SPECIALTY

Ambulance● Ambulance Fee Schedule (Podcast)● Medicare Ambulance Transports

Cardiology● Cardiovascular Nuclear Medicine – Medicare

Quarterly Compliance Newsletter, Vol. 5, Issue 3, Apr. 2015, p. 14

● Heart Failure and Shock – Medicare Quarterly Compliance Newsletter, Vol. 4, Issue 4, July 2014, p. 8

● Implantable Automatic Defibrillators – Medicare Quarterly Compliance Newsletter, Vol. 5, Issue 1, Oct. 2014, p. 8

● Transcatheter Aortic Valve Replacement/Implantation (TVR/TAVI) – Medicare Quarterly Compliance Newsletter, Vol. 5, Issue 3, Apr. 2015, p. 7

Chiropractic● Chiropractic Services● Chiropractic Services – Medicare Quarterly

Compliance Newsletter, Vol. 3, Issue 3, Apr. 2013, p. 1

● SE1101 Overview of Medicare Policy Regarding Chiropractic Services

● SE1602 Use of the AT modifier for Chiropractic Billing

General Surgery● Global Surgery● Surgical Procedures Related to Hemodialysis

Access – Medicare Quarterly Compliance Newsletter, Vol. 5, Issue 2, Jan. 2015, p. 14

Home Health● Home Health Certification – Medicare Quarterly

Compliance Newsletter, Vol 3, Issue 4, July 2013, p. 1

● SE1436 Certifying Patients for the Medicare Home Health Benefit

● The Medicare Home Health Benefit● Validation of Last Episode Timing – Medicare

Quarterly Compliance Newsletter, Vol. 5, Issue 3, Apr. 2015, p. 18

Hospice● Hospice Payment System● Hospice Related Services – Part B – Medicare

Quarterly Compliance Newsletter, Vol. 3, Issue 2, Jan. 2013, p. 1

● Hospices Web Page

Diagnostic Radiology and Imaging Services● Medicare Coverage of Imaging Services● MRI Scans – Medicare Quarterly Compliance

Newsletter, Vol. 4, Issue 2, Jan. 2014, p. 7● Provider Compliance Tips for Computed

Tomography (CT) Scans● SE1122 Important Reminders about Advanced

Diagnostic Imaging (ADI) Accreditation Requirements

● SE1134 Medicare Payments for Diagnostic Radiology Services in Emergency Departments

Durable Medical Equipment (DME)● CMS Provider Minute: Enteral Infusion

Pumps (Video)● Coudé Tip Catheters – Medicare Quarterly

Compliance Newsletter, Vol. 5, Issue 4, July 2015, p. 1

● Home Oxygen Therapy● Incorrect Billing of DME Orthotics – Medicare

Quarterly Compliance Newsletter, Vol. 5, Issue 4, July 2015, p. 21

● Power Mobility Devices: Complying with Documentation & Coverage Requirements

● Provider Compliance Tips for Diabetic Test Strips● Provider Compliance Tips for Enteral

Nutrition Pumps● SE1103 Capped Rental DME: Enforcement of

Payment Requirements for Beneficiary-owned Capped Rental Durable Medical Equipment (DME)

● SE1112 Power Mobility Device Face-to-Face Examination Checklist

● The DMEPOS Competitive Bidding Program – A Better Way for Medicare to Pay for Medical Equipment

Hospital● Guidelines for Teaching Physicians, Interns,

and Residents● MLN Suite of Products and Resources for

Inpatient Hospitals● Post Acute Transfer – Medicare Quarterly

Compliance Newsletter, Vol 5, Issue 3, Apr. 2015, p. 16

● SE0622 Clarification of Medicare Payment Policy When Inpatient Admission Is Determined Not To Be Medically Necessary, Including the Use of Condition Code 44: “Inpatient Admission Changed to Outpatient”

● SE0801 Clarification of Patient Discharge Status Codes and Hospital Transfer Policies

● SE1121 Recovery Audit Program Diagnosis Related Group (DRG) Coding Vulnerabilities for Inpatient Hospitals

Neurology● Acute Inpatient Neurological Disorders –

Medically Unnecessary Items or Services Provided in a Medically Unnecessary Setting – Medicare Quarterly Compliance Newsletter, Vol. 2, Issue 4, July 2012, p. 7

Oncology● Chemotherapy Administration and

Non-Chemotherapy Injections and Infusions – Incorrect Coding – Medicare Quarterly Compliance Newsletter, Vol. 1, Issue 2, Feb. 2011, p. 4

● MM5729 Unlabeled Use for Anti-Cancer Drugs: Medical Literature used to Determine Medically Accepted Indications for Drugs and Biologicals used in Anti-Cancer Treatment

Pulmonology● Pulmonary Procedures and Evaluation &

Management Services – Medicare Quarterly Compliance Newsletter, Vol. 3, Issue 4, July 2013, p. 25

Therapy Services● 11 Part B Billing Scenarios for PTs and OTs

(Individual vs. Group Treatment)● Example of Insufficient Documentation –

Physical Therapy Plan of Care - Medicare Quarterly Compliance Newsletter, Vol. 5, Issue 1, Oct. 2014, p. 19

● Inpatient Rehabilitation Therapy Services: Complying With Documentation Requirements

Urology● SE1210 Recovery Auditors Findings Resulting

from Medical Necessity Review of Renal and Urinary Tract Disorders

Skilled Nursing Facility● 3-Day Qualifying Hospital Stay for Skilled Nursing

Facility Stays – Medicare Quarterly Compliance Newsletter, Vol. 2, Issue 3, Apr. 2012, p. 1

● Medicare-Required SNF PPS Assessment● Skilled Nursing Facility (SNF) Billing Reference● Skilled Nursing Facility (SNF) Level of Care

Review – Medicare Quarterly Compliance Newsletter, Vol. 5, Issue 1, Oct. 2014, p. 6

Part A/Part B Fee-For-Service (FFS) Providers● Complying with Medical Record

Documentation Requirements● Complying with Medicare Signature

Requirements● Evaluation and Management Services Guide● Medicare Basics: Commonly Used Acronyms● Medicare Billing: 837I and Form CMS-1450● Medicare Billing: 837P and Form CMS-1500● Medicare Costs at a Glance● MM6698 Signature Guidelines for Medical

Review Purposes● Place of Service Code Set● Safeguard Your Identity and Privacy

Using PECOS● SE1104 The Importance of Correctly Coding

the Place of Service by Physicians and Their Billing Agents

● SE1226 Reminder of Importance of Correct Place-of-Service Coding on Medicare Part B Claims

Web-BasedTraining

How to Find Free Courses1. Go to the MLN Learning Management

and Product Ordering System (LM/POS)

2. Create an account or log in to the LM/POS

3. Select “Training Catalog”

4. You may browse by category by selecting one of the categories that appear. To browse all products, leave the “Search for” field blank, and select “Search”

Popular CoursesContinuing Education Credits

● Affordable Care Act Provider Compliance Programs: Getting Started

● Certificate of Medical Necessity

● Diagnosis Coding: Using the ICD-10-CM

● Drug Diversion: Do You Know Where the Drugs Are Going?

● HIPAA EDI Standards

● Medicare Billing: 837I and Form CMS-1450

● Medicare Billing: 837P and Form CMS-1500

● Medicare Fraud and Abuse: Prevention, Detection, and Reporting

● Medicare Secondary Payer Provisions

● Safeguarding Your Medical Identity

● World of Medicare

● Your Institution in the World of Medicare

● Your Office in the World of Medicare

Standard Courses

● Uniform Billing (UB-04)

● Medicare Billing Certificate Program for Part A Providers

● Medicare Billing Certificate Program for Part B Providers

Visit the MLN at http://go.cms.gov/MLNGenInfo on the CMS website.

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