Claims Processing Manual

This manual contains billing requirements, rules, and regulations as they pertain to Medicare in all settings. This manual provides information on completing the CMS-1500 claim form used by physical and occupational therapists in private practice. In addition, it provides instructions for the completion of the UB-92 (CMS-1450) claim form used by providers of physical therapy, occupational therapy, and speech-language pathology services in all other settings besides private practice. It also describes the use of Advance Beneficiary Notices (ABN’s) and Notice of Exclusion From Medicare Benefits (NEMB’s), as well as the Medicare appeals process for denied claims.

Listed below are crucial chapters that organizations should familiarize themselves with:

Chapter 5-Part B Outpatient Rehabilitation and CORF Services
This chapter contains information on the Medicare Therapy Cap, Medicare’s “8” minute rule, use of therapy specific modifiers, and other important information relevant to the billing and reimbursement of outpatient therapy services under Medicare Part B benefits.
Chapter 6: SNF Inpatient Part A Billing
Chapter 7: SNF Part B (including inpatient Part B and outpatient)
Chapter 10: Home Health Agency Billing
Chapter 20: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Chapter 25: Completing and Processing UB-92 (CMS-1450) Data Set
Chapter 26: Competing and Processing Form CMS-1500 Data Set
Chapter 29: Appeals of Claims Decisions
Chapter 30: Financial Liability Protections

This chapter contains information on the use of Advance Beneficiary Notices in all settings as well as information on Notice of Exclusion From Medicare Benefits.

To access the Medicare Claims Processing Manual from the CMS website, please click on the link below and choose the appropriate chapter.

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