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x Hospice
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x ICD-9
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National Home Infusion Billing Guide

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Aetna Policy Manual
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Chapter 12 - Physicians/Nonphysician Practitioners
Chapter 13 - Radiology Services and Other Diagnostic
Chapter 16 - Laboratory Services
Chapter 18 - Preventive and Screening Services
Chapter 19 – Indian Health Services
Chapter 2 - Admission and Registration Requirements
Chapter 22 - Remittance Advice
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www.cms.hhs.gov/mcrpartbdrugavgsalesprice

x Medicare National Coverage Det
Chapter 1 Part 1
Chapter 1 Part 2
Chapter 1 Part 3
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x Medicaid
471-000-55 Nebraska Medicaid Billing Instructions for Durable Medical Equipment,
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Bulletins
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Hysterectomy Consent Form
IA Medicaid Billing Guide
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IA Medicaid Fee Factor Pymt Codes
Injectables Fee Schedule
Iowa Medicaid Appeal Process
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Iowa Medicaid Preferred Drug List
Iowa Medicaid Provider Site
Medicaid Ne Index
Medicaid Paper Manual
Medicaid Provider Manual Part 2
Mental Health Fee Schedule
NE Medicaid Manual
Nebraska Medicaid Covered Servies
Physician Fee Schedule
Physician Fee Schedule
Physician Fee Schedule Manual
Policy Staff Contact
Provider Bulletins
Provider Handbook Behavioral H NE MD
Provider Handbooks
Provider Manual NE Medicaid
Provider Manual NE Medicaid (Physician)
State Medicaid Manual Part 2
State Medicaid Site with Manuals
Sterilization Consent Form
Title 467 -- Title V Services for Medically Handicapped Children, Genetically Ha
Title 468 -- Aid to Dependent Children (ADC) and the Nebraska Medical Assistance
Title 469 -- Assistance to the Aged, Blind, or Disabled, Nebraska Medical Assist
Title 471 -- Nebraska Medical Assistance Program Services
Title 472 -- The Disabled Persons and Family Support Program
Title 473 -- Social Services for Aged and Disabled Adults

x Medicare Benefit Manual
Chapter 1 - Inpatient Hospital Services Covered Under Part A
Chapter 10 - Ambulance Services
Chapter 11 - End Stage Renal Disease (ESRD)
chapter 12
Chapter 12 - Comprehensive Outpatient Rehabilitation Facility
Chapter 13 - Rural Health Clinic (RHC) andFederally Qualified Health Center (FQH
chapter 14
Chapter 14 - Medical Devices
chapter 15
Chapter 15 – Covered Medical and Other Health Services
Chapter 16 - General Exclusions From Coverage
Chapter 2 - Inpatient Psychiatric Hospital Services
Chapter 3 - Duration of Covered Inpatient Services
Chapter 4 - Inpatient Psychiatric Benefit Days Reduction and lifetime benefit
Chapter 5 - Lifetime Reserve Days
Chapter 6 - Hospital Services Covered Under Part B
Chapter 7 - Home Health Services
Chapter 8 - Coverage of Extended Care (SNF) Services
Chapter 9 - Coverage of Hospice Services Under hospital insurance

x Medicare Claims Processing Man
Chapter 1 - General Billing Requirements
Chapter 10 - Home Health Agency Billing
Chapter 11 - Processing Hospice Claims
Chapter 13 - Radiology Services and Other Diagnostic Procedures
Chapter 14 - Ambulatory Surgical Centers
Chapter 15 - Ambulance
Chapter 16 - Laboratory Services
Chapter 17 - Drugs and Biologicals
Chapter 18 - Preventive and Screening Services
Chapter 19 – Indian Health Services
Chapter 2 - Admission and Registration Requirements
Chapter 20 - Durable Medical Equipment, Prosthetics,
Chapter 21 - Medicare Summary Notices
Chapter 22 - Remittance Advice
Chapter 23 - Fee Schedule Administration and Coding requirements
Chapter 24 – General EDI and EDI Support
Chapter 25 - Completing and Processing the Form CMS 1450
Chapter 26 - Completing and Processing CMS 1500
Chapter 27 - Contractor Instructions for CWF
Chapter 28 - Coordination With Medigap, Medicaid,
Chapter 29 - Appeals of Claims Decisions
Chapter 3 - Inpatient Hospital Billing
Chapter 30 - Financial Liability Protections
Chapter 31 - ANSI X12N Formats Other than Claims
Chapter 32 – Billing Requirements for Special Services
Chapter 33 – Miscellaneous Hold Harmless Provisions
Chapter 34 - Reopening and Revision of Claim redeterminations
Chapter 4 - Part B Hospital
Chapter 5 - Part B Outpatient Rehabilitation
Chapter 6 - SNF Inpatient Part A Billing
Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Suppli
Chapter 9 - Rural Health Clinics /
Incident To Provisions

x Medicare New Provider Manual
Becoming a Medicare Provider/supplier
Evaluation and Management Chapter 5
Inquiriers Overpayments Appeals Chapt 7
Introduction to Medicare
Medicare Payment Policies
Medicare Reimbursement Chapt 3
Protecting Medicare Trust fund chapt 6

x Mid Levels
Am College of Nurse Practitioners
ARNP
In and Outs of Billing Mid Levels

x Modifiers
alpha numeric modifiers approved by cms
Decision Tree Modifiers Pinnacle Medicare
Grid on how modifiers affect reimbursement
Mod 59 CCI Edit Article
Modifier 25 report
Modifier 58 WPS
Modifier 59 article proper usage
Modifier 59 report