Medicare Resources

Medicare Physician Fee Schedule Lookup: Obtain the relative value units, fee schedule status indicators, and various payment policy indicators needed for payment adjustments. The Medicare physician fee schedule pricing amounts are adjusted to reflect the variation in practice costs from area to area.

Medicare Enrollment: Resources and updates on Medicare enrollment and on National Provider Identifiers (NPI) 

Summaries of Regulations and Comment letters: Obtain information on the Academy's summaries of regulations from CMS and analysis of the impact of these rules on the specialty of otolaryngology - head and neck surgery.

Updates and News: Medicare Transmittals, Medlearn Matters Articles, and announcements from CMS

Medicare Administrative Contractors (MAC): Information on the Implementation of the MACs including regional maps of their jurisdictions, weblinks to their local coverage determinations and their effective dates of coverage.

Recovery Audit Contractors (RAC): Get information on the RACs and access their Issues lists.

National Correct Coding Institute (NCCI):CMS created NCCI edits to prevent improper payment when incorrect code combinations are reported.The NCCI contains two tables of edits.The Column One/Column Two Correct Coding Edits table and the Mutually Exclusive Edits table include code pairs that should not be reported together for a number of reasons explained in Medicare's Coding Policy Manual. 

Medically Unlikely Edits (MUE): CMS developed MUEs to reduce the paid claims error rate for Part B claims.  An MUE for a HCPCS/CPT code is the maximum units of service that a provider can report under most circumstances for a patient on a single date of service. CMS updates the MUEs quarterly.

Red Flag Rules: The Federal Trade Commission (FTC) defines red flags as "a pattern, practice, or specific activity that could indicate identity theft.” The Red Flag rules mandate businesses to adopt written measures to detect, prevent and mitigate
identity theft. They are effective from December 31, 2010.

Documents and Forms: Medicare Provider Enrollment forms, Provider Participation Application forms, Appeal forms, and Advance Beneficiary Notice Forms.

Physician Practice Information Survey (PPIS) - Summary Report for Otolaryngology: The Physician Practice Information Survey (PPIS) is a multi-specialty practice expense survey of physicians and other health care providers (such as podiatrists, audiologists,
chiropractors, etc.) in the US. The primary purpose of the survey was to aggregate practice expense per hour (PE/HR) data to obtain accurate and reliable data on practices’ direct costs for equipment, supplies and wages for clinical staff.  

PPIS Summary Report for All Specialties