| Useful Websites for Clinical Laboratory Billing |  |
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ABN:Claims with Incorrect ICD Codes: Clinical Laboratory Management Association Publication: www.clma.org/ Draft ABN: ABN: When to use GA, GZ AND GY modifiers: www.cms.gov/medlearn/modchtga.pdf Revisions to Draft ABN: www.cms.hhs.gov/medicare/bni/draft.pdf Home Health: ABN's: HCFA Issues Program Memorandum on Medicare Home Health Beneficiary Notices: www.cms.hhs.gov/manuals/pm_trans/A0105.pdf Compliance:Fraud and Abuse: Consequences: questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php? Legal Corner: Final Stark II Regulation: www.access.gpo.gov/su_docs/aces/aces140.html OIG Model Compliance Plan for Clinical Laboratories: www.oig.hhs.gov/fraud/docs/complianceguidance/cpcl.html OIG Model Compliance Guidance for Small Physician Practices www.oig.hhs.gov/authorities/docs/physician.pdf Safety Needle: Bloodbourne Pathogens standard: frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2001_register&docid=01-1207-filed Training Information: OIG Program Exclusions: www.oig.hhs.gov/fraud/exclusions/listofexcluded.html Miscellaneous: Medicare Payments for the Same Service by More Than One Carrier: www.hhs.gov/oig/oei/whatsnew.html OIG's Corporate Integrity Agreements: www.oig.hhs.gov/fraud/cia/ Correct Coding Initiative:Commercial Coding Edits: www.cms.hhs.gov/manuals/pm_trans/B0167.pdf National Correct Coding Policy Manual for Part B Carriers: www.ntis.gov/index.html Dialysis:Medicare: ESRD Billing Guide from Pennsylvania Medicare: www.hgsa.com/professionals/bguides/esrd.shtml Lab Services Included Under Composite Rate: Separately Billed ESRD Hospital Outpatient Laboratory Tests Included in the Composite Rate: www.oig.hhs.gov/oas/reports/region1/19600513.pdf Dialysis Rates: Composite Payment Rates Effective January 1, 2002, Urban & Rural Renal Facilities www.trailblazerhealth.com/parta/esrd/comprate.asp Eligibility:Eligibility Verification: Oxford Health Plans: www.oxhp.com Blue Cross Blue Shield: https://provider.blueshieldca.com/cgi-bin/gx.cgi/AppLogic+PCMainPage CHAMPUS: www.mytricare.com Blue Cross of California: www.bluecrossca.com GHI: www.ghi.com Cigna: www.cigna.com Health Net: www2.healthnet.com/providers/preview HIPAA:General: www.cms.gov/hipaa Overview: www.cms.gov/hipaa/hipaa1/default.asp HIPAA FAQ web site for electronic transactions: aspe.hhs.gov/admnsimp/ASCA%20FAQs-1-31.htm HHS Announces Electronic Standards: Electronic transactions and code sets: http://aspe.hhs.gov/admnsimp/ Medical Records Confidentiality Rule: Final Medical Records Confidentiality Rule: aspe.hhs.gov/admnsimp/final/press2.htm Reason Code: www.wpc-edi.com/ClaimAdjustment_40.asp Hospital:Medicare Billing Guidelines for Hospital Laboratories: Advisory Opinion No. 00-9: www.oig.hhs.gov/fraud/docs/advisoryopinions/2000/ao00_9.pdf Outpatient Prospective Pay: Proposed Rule 2003: www.cms.hhs.gov/regulations/hopps/cms1206p.asp Quick Reference Guide: www.cms.gov/medlearn/refopps.asp Transmittal A-01-41: www.cms.gov/manuals/pm_trans/A0141.pdf Program Memorandum A-01-01: www.cms.gov/manuals/pm_trans/A0101.pdf Provider Based Issues/Frequently Asked Questions: questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid Managed Care:Knox-Keene: www.hmohelp.ca.gov/library/regulations/ Non-Payment Action Plan (CA): www.dmhc.ca.gov/ Medicaid:Medicaid State and Federal Medicaid Contacts: www.cms.hhs.gov/medicaid/mcontact.asp Medicaid Assistance Resources by State: www.agenet.com/medicaid_state_contacts.html Medi-CAL: www.medi-cal.ca.gov/ Medicare:CMS: www.cms.hhs.gov CMS Outlines Policies Related To Processing Clinical Lab Claims: www.cms.gov/manuals/pm_trans/AB02030.pdf Fee Schedule: www.cms.gov/paymentsystems/ NHIC Carrier: www.medicarenhic.com Clinical Trials: www.cms.gov/coverage/8d.asp Intermediary/Carrier Directory Part A and Part B by State: www.cms.hhs.gov/contacts/incardir.asp Medicare + Choice: Expecting list fees from non-contracted groups: www4.law.cornell.edu/uscode/42/ Patient Records via the Internet: www.cms.gov/manuals/pm_trans/AB02145.pdf 855 Form: www.cms.gov/providers/enrollment/forms/ Medicare Advisory Committee: www.medpac.gov Staff Training:Policy for Diagnosis: Medicare Learning Network: www.cms.gov/medlearn/cmshowto.asp Helpful Laboratory Billing Resources:AHA: www.aha.org AMA: www.ama-assn.org California Code of Regulations: ccr.oal.ca.gov California Law: www.leginfo.ca.gov/calaw.html CLIA: www.cms.gov/clia/ CLMA: www.clma.org CCI: www.ntis.gov Dark Report: www.darkreport.com Department of Health and Human Services: www.hhs.gov/ Dialysis: www.hgsa.com/professionals/bguides/esrd.shtml FDA: www.fda.gov/ Federal Register-Program Exclusions: www.oig.hhs.gov/fraud/exclusions/listofexcluded.html Government News: www.aishealth.com/GovernmentNews.html Government Accounting Office: www.gao.gov Health Lawyers: www.healthlawyers.org License Finder for Physicians: www.docfinders.org LMRPs: www.lmrp.net LOINC: www.regenstrief.org Long Term Care: www.longtermcare.com Medical Societies: www.medem.com Medical Legal, Governmental, Regulatory and Compliance Resources: www.pohly.com National Conference of State Legislatures: www.ncsl.org National Coverage Determinations: www.cms.hhs.gov/coverage/8b3.asp Negotiated Rule-Making: www.access.gpo.gov/su_docs/fedreg/a011123c.html OIG: oig.hhs.gov/ OSHA Standards: www.osha.gov Physician License Look-Up: www.citizen.org/hrg/publications/1506summary1.htm Program Integrity Manual: www.cms.hhs.gov/manuals/108_pim/pim83toc.asp Record Retention: http://library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_012545.html Stark II: www.opm.gov/fedregis/html/archive.htm Title 42: caselaw.lp.findlaw.com/scripts/ts_search.pl?title=42&sec=1395 UPIN Database: www.upinregistry.com/_Misc/intro.asp Washington G2: www.g2reports.com/
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