Menu

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.hotbot.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.)  (AMA limits # searched to 5 per day)(will need to create free login and password)

https://commerce.ama-assn.org/store/catalog/subCategoryDetail.jsp?category_id=cat1150007&navAction=push

CPT® Errata:

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

 

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

https://commerce.ama-assn.org/store/search/searchResults.jsp?search=CPT+Assistant

 

For Code Books: ICD-10-CM

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

https://www.cms.gov/medicare/coding/icd10/downloads/icd-10overview.pdf (ICD-10-CM/PCS The Next Generation of Coding)

https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html (2017 ICD-10-CM and GEMs)

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

 

American Hospital Association (AHA) Central Office

http://www.ahacentraloffice.org

Publisher of AHA Coding Clinic for ICD-9-CM & ICD-10-CM

Publisher of Faye Brown’s ICD-9-CM Coding Handbook 2015

Publisher of ICD-10-CM and ICD-10-PCS Coding Handbook 2017

 

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:

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

 

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 RVU17C (click on 2017 @ left)
Click on RVU17C and then click Open
Double-click on RVU17C.pdf, open and print out
Double-click on PPRRVU17_JULY_V0503 (or latest version) (the Excel file)
For GPCIs, double-click on CY2017_GPCIs (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):

http://www.cms.gov/mcd/overview.asp

Click on Search

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 Modifier -59 Article

Click on NCCI Policy Manual for Medicare Services

  • Click open and print Intro & Table of Contents 1st, then selected chapters
  • For chapter-specific bundling examples, read Correspondence Language Manual for Medicare Services, then close and scroll back up to top

Click on PTP Coding Edits

  • Open Practitioner PTP Edits
  • 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):
Go to: https://www.cms.hhs.gov/pqrs/

Click on Measures Codes
Scroll down and click on 2016 PQRS Measures List

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.

 

Value Based Modifier:
https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.html

Electronic Health Records (EHR) Incentive Programs:
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprogramsincentiveprogram
The Medicare EHR Incentive Program for returning eligible professionals (EPs) ended with the 2016 reporting period. Starting in 2017, Medicare eligible clinicians will report to the Quality Payment Program. The attestation deadlines for an EHR reporting period to avoid the 2018 payment adjustment for returning EPs was March 13, 2017. First time EPs who have not demonstrated meaningful use successfully in a prior year have until October 1, 2017 to attest or apply for the one-time hardship exception if they are transitioning to MIPS in 2017. To learn more about the Quality Payment Program, visit the official website. Subscribe to the Quality Payment Program listserv for updates.

Quality Payment Program: Delivery System Reform, Medicare Payment Reform, & MACRA:
https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2016-11-15-QPP.html
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):

http://www.ama-assn.org/ama/pub/advocacy/state-advocacy-arc/state-advocacy-campaigns/private-payer-reform/state-based-payment-reform/evaluating-payment-options/pay-for-performance.page
 

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

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

Physician Compare Search Tool
https://www.medicare.gov/physiciancompare/search.html

You can find out which physicians, other healthcare professionals, and group practices take part in Medicare’s quality programs including:

  • Physician Quality Reporting System (PQRS), including the Group Practice Reporting Option (GPRO)
  • PQRS Maintenance of Certification Program Incentive
  • Consumer Assessment of Healthcare Providers & Systems for PQRS
  • Electronic Prescribing (eRx) Incentive Program
  • Electronic Health Record (EHR) Incentive Program
  • Million Hearts®

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/frontpage?qt-audience_hero_frontpage=0#qt-audience_hero_frontpage

 

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 email update messages

http://www.cms.gov/Medicare/Coding/ICD10/CMS_ICD-10_Industry_Email_Updates.html

ICD-10-CM Provider Resources

https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

General Equivalency Mappings (GEMs)

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

 

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

 

For OIG Compliance Program for Individual and Small Group Physician Practices:

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

 

Compliance Guidance on OIG website:

http://oig.hhs.gov/fraud/complianceguidance.asp

 

Compliance Resource Material on OIG website:

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

 

For OIG Annual Work Plan:

http://oig.hhs.gov/publications/workplan.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

Click on Recent Updates

Click on Provider Resource, then Provider Options Chart

 

For Regulatory & Compliance Topics:

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

 

For Health System Reform Resources:

http://www.ama-assn.org/ama/pub/advocacy/topics/affordable-care-act.page

 

Contact your medical specialty society

Specialty Definitions

http://www.medicare.gov/physiciancompare/staticpages/resources/specialtydefinitions.html

 

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

Medisense is a private occupational school that offers medical coding certification courses in Colorado Springs and online with a stated mission of “Making Sense of Medical Coding.”

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