Helpful Websites:

Resources for Coders:

http://www.aapc.com/resources/index.aspx

 

Search Engines:

http://www.google.com

http://www.yahoo.com

http://www.askjeeves.com

http://www.bing.com

 

For Medical Encyclopedia & Dictionary:

http://health.nih.gov/

http://www.nlm.nih.gov/

http://medlineplus.gov/

http://www.medscape.com/medscapetoday/resource

http://www.instantanatomy.net/sitemap.html

http://medical-dictionary.thefreedictionary.com/

 

For Code Books: CPT^®

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page

https://www.ama-assn.org/practice-management/find-coding-resources  (CPT Code/Relative Value Search, CPT Professional Edition, CPT Assistant Newsletter, etc.)

https://commerce.ama-assn.org/store/ui/search/searchResults?search=cpt

CPT® Errata:

https://www.ama-assn.org/search?search=CPT+errata

 

CPT^® Assistant (Monthly newsletter published by the AMA):

https://commerce.ama-assn.org/store/ui/search/searchResults?search=CPT%20Assistant

 

For Code Books: ICD-10-CM

http://www.cdc.gov/nchs/icd/icd10cm.htm

https://www.cms.gov/Medicare/Coding/ICD10/index.html (ICD-10)

http://www.icd10data.com/ (ICD-10-CM)

 

American Hospital Association (AHA) Central Office

http://www.ahacentraloffice.org

Publisher of AHA Coding Clinic for ICD-10-CM

Publisher of ICD-10-CM and ICD-10-PCS Coding Handbook

 

For Code Books: HCPCS

http://www.cms.hhs.gov/MedHCPCSGenInfo/

http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp#TopOfPage

http://www.hcpcsdata.com/

 

For Evaluation & Management:

CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes: https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

1995 Documentation Guidelines:
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnedwebguide/downloads/95docguidelines.pdf

1997 Documentation Guidelines:
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnedwebguide/downloads/97docguidelines.pdf

Complying with Medical Record Documentation Requirements:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CERTMedRecDoc-FactSheet-ICN909160.pdf

Evaluation & Management Services Guide:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf

Complying with Medicare Signature Requirements:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Signature_Requirements_Fact_Sheet_ICN905364.pdf
 

For ICD-10-CM Official Guidelines for Coding and Reporting:

http://www.cdc.gov/nchs/icd/icd10cm.htm

 

Four Cooperating Parties for ICD-10-CM:

American Hospital Association (AHA)

http://www.aha.org/

American Health Information Management Association (AHIMA)

http://www.ahima.org/

Centers for Medicare and Medicaid Services (CMS)

http://www.cms.gov

National Center for Health Statistics (NCHS)

http://www.cdc.gov/nchs/index.htm

 

MPFSDB – Medicare Physician Fee Schedule Database
http://www.cms.hhs.gov/PhysicianFeeSched/
Click on PFS Relative Value Files
Choose RVU21C (click on 2021 @ left) (RVU current year, current quarter – A, B, C or D)

Click on RVU21C and then click Open
Double-click on RVU21C.pdf, open and print out
Double-click on PPRRVU21_JUL (or latest version) (the Excel file)
For GPCIs, double-click on GPCI2021 (the Excel file)

 

Medicare Administrative Contractor (MAC): What is a MAC?
https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/What-is-a-MAC.html

A/B MAC Jurisdictions: Who are the MACs?
https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html

For National Coverage Determinations (NCDs) or Local Coverage Determinations (LCDs):

Medicare Coverage Database

https://www.cms.gov/medicare-coverage-database/new-search/search.aspx?redirect=Y&from=Overview

Enter keyword, code or document ID and choose the State

Can search NCDs and/or LCDs

By document ID OR

By state or region & by key words in the title and/or CPT/HCPCS code

 

CCI: Correct Coding Initiative

http://www.cms.hhs.gov/NationalCorrectCodInitEd/
Scroll down and print the How to Use the Medicare National Correct Coding Initiative (NCCI) Tools
Scroll down and print the Proper Use of Modifier -59 Article
For chapter-specific bundling examples, read Correspondence Language Manual for Medicare Services, then close and scroll back up to top
Click on NCCI Policy Manual for Medicare

Click open and print Introduction, then selected chapters

Click on PTP Coding Edits

Open Practitioner PTP Edits for code range & quarter you need
Save files to your computer to use to edit your multiple procedure claims and to file appeals

Column 1 represents the comprehensive procedure; Column 2 represents the components

Rename each file by quarter and by year for later reference for appeals or postpayment audit (If you need to reference older versions, you will need to purchase them)

There are also Add-on Code Edits found here

Risk Adjustment:

Medicare Advantage Risk Adjustment (for Medicare Part C):

ICD-10-CM to Hierarchical Condition Categories (HCC) Mappings:

https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html

Announcements (including the Risk Adjustment Factors [RAF] by HCC) and Other Documents:

https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents.html

Commercial Risk Adjustment (under the Affordable Care Act [ACA]):

The Center for Consumer Information & Insurance Oversight (CCIIO):

https://www.cms.gov/cciio/index.html

Health and Human Services Hierarchical Condition Category (HHS-HCC) Model under the ACA:

https://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a03.html

 

The ICD-10 crosswalk is posted on the CCIIO webpage under the section labeled “Premium Stabilization Programs,” under “Regulations & Guidance” in Excel format for your review (https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html).

https://www.cms.gov/cciio/Resources/Regulations-and-Guidance/index.html#Premium Stabilization Programs (this site can be accessed through the link above this one)

 

Health Insurance Marketplace:

https://marketplace.cms.gov/index.html

 

Physician Quality Reporting System (PQRS, formerly known as Physician Quality Reporting Initiative
or PQRI) (for Medicare Part B):

2016 was the last program year for PQRS. PQRS transitioned to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program. The final data submission timeframe for reporting 2016 PQRS quality data to avoid the 2018 PQRS downward payment adjustment was January through March 2017. The first MIPS performance period is January through December 2017. For more information, please visit the Quality Payment Program website. (See more information on QPP below.)

Electronic Health Records (EHR) Incentive Programs (promoting interoperability):
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprogramsincentiveprogram

Quality Payment Program: Delivery System Reform, Medicare Payment Reform, & MACRA:

https://qpp.cms.gov/

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html

Pay for Performance (P4P or PFP):

https://www.ama-assn.org/search?search=Pay+for+Performance  

Payment for Quality (P4Q):

National Committee for Quality Assurance (NCQA)

http://www.ncqa.org/

Healthcare Effectiveness Data and Information Set (HEDIS) and Performance Measurement

http://www.ncqa.org/HEDISQualityMeasurement.aspx 

Five-Star Quality Rating System

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS.html

http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html?q=Star+ratings

Based on provider and plan performance, quality of care data and patient surveys

Physician Compare Initiative (Medicare Care Compare)

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/

• Physician Compare Search Tool (Medicare Care Compare) https://www.medicare.gov/care-compare/ Find information about providers and facilities based on your individual needs
• Get helpful resources to choose your health care providers
• Make more informed decisions about where you get your health care

For Practice Administration Tools:

http://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Center.html

http://www.cms.hhs.gov/center/practice.asp

http://www.cms.hhs.gov/center/provider.asp

http://www.cms.hhs.gov/center/physician.asp

http://www.cms.hhs.gov/center/dme.asp

http://www.cms.hhs.gov/center/hha.asp

http://www.cms.hhs.gov/center/hospital.asp

Anesthesiologists Center:

http://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.html

CLIA Information:

https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/

American Medical Association (AMA):

Top Resources by Audience

https://www.ama-assn.org/search?search=Top+Resources+by+Audience  

Administrative Simplification Initiatives

https://www.ama-assn.org/practice-management/hipaa-administrative-simplification

https://www.ama-assn.org/practice-management/administrative-simplification-advocacy 

American Academy of Family Physicians (AAFP):

http://www.aafp.org/fpm/toolBox/viewToolBox.htm?cmpid=_van_197 

List Servs:

Receive CMS.gov email updates for various topics of your choice

http://www.cms.gov/About-CMS/Agency-Information/Aboutwebsite/EmailUpdates.html

ICD-10-CM Latest news and resources

http://www.cms.gov/Medicare/Coding/ICD10/index.html?rediret=ICD10 

ICD-10-CM Provider Resources

https://www.cms.gov/Medicare/Coding/ICD10/ICD-10Resources

For HIPAA Compliance Plan:

https://www.ama-assn.org/practice-management/hipaa-compliance

HIPAA Basics for Providers:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HIPAAPrivacyandSecurity.pdf

Office for Civil Rights (enforces HIPAA Privacy, Security and Breach Notification Rules)
http://www.hhs.gov/ocr/index.html  

OIG Compliance Program for Individual and Small Group Physician Practices:

http://oig.hhs.gov/authorities/docs/physician.pdf 

Compliance Guidance on OIG website:

https://oig.hhs.gov/compliance/compliance-guidance/index.asp

Compliance Resource Material on OIG website:

https://oig.hhs.gov/compliance/compliance-guidance/compliance-resource-material.asp 

For OIG Annual Work Plan:

https://oig.hhs.gov/reports-and-publications/workplan/index.asp  

For Recovery Audit Contractor (RAC) Audits:

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/index.html

Scroll down for Recent Updates

For Regulatory & Compliance Topics:

https://www.ama-assn.org/search?search=Regulatory%20and%20Compliance%20Topics&sort_by=search_api_relevance&page=0  

Health System Reform Resources:

https://www.ama-assn.org/search?search=Health+System+Reform

COVID-19 Resources

https://www.cdc.gov/coronavirus/2019-ncov/index.html

https://covid.cdc.gov/covid-data-tracker/#datatracker-home

Public Health Emergency Declarations

Telehealth Technologies during Coronavirus

Billing for telehealth during COVID-19

Contact your medical specialty society

Specialty Definitions

https://jamanetwork.com/journals/jama/fullarticle/197214

National Specialty Societies (courtesy of the Texas Medical Association)

http://www.texmed.org/Template.aspx?id=3373 

American Board of Medical Specialties

http://www.abms.org/member-boards/contact-an-abms-member-board/

Contact your insurance commissioner

http://www.naic.org/state_web_map.htm

Contact your elected officials

http://www.usa.gov/Contact/Elected.shtml