(Medicare Claims Processing Manual Crosswalk)

Medicare Claims Processing Manual Chapter 8 - Outpatient ESRD Hospital, Indepe ndent Facility, and Physician/Supplier Claims Crosswalk  New Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provider Reimburse Part 1 PMs                                                                              Other Description8 10 A3-3166   RDF-206 PRM1-2702   General Description of ESRD Payment 8 10.1 A3-3166 RDF-245,RDF-245.2 PRM1-2702   General Description of ESRD Facility Composite Rates  8 10.2 PRM1-2702.1 Uncompleted Treatments8 10.3 PRM1-2702.1 No-Shows8 10.4 RDF-112,RDF-114 Deductible and Coinsurance8 10.5 PRM1-2702.1C   Outpatient Hospital Services Which Become Inpatient Hospital Services 8 10.6 PRM1-2706.1E Amount of Payment8 10.7    RDF-221    ESRD Services Not Provided Within the United States 8 10.8 RDF-207.4 Transportation Services8 20 Definitions Related to CalculatingComposite Rate - section heading only 8 30 Determination and Publication ofComposite Rate - section heading only New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 30.1       PRM1-2706.1,PRM1-2704, PRM1-2706 42 CFR 413.172  Publication of Composite Rates 8 30.2                                                                     PRM1-2706.1 Determining Individual Facility Composite Rate 8 30.3 PRM1-2705 Transition Period8 30.4 PRM1-2717 Record Keeping and ReportingRequirements Under Composite Rate System 8 30.5 PRM1-2728 Facility  Preparation and Intermediary Review of Cost Reports 8 30.6 PRM1-2719 Issuance of Notice of ProgramReimbursement 8 40 PRM1-2720 Processing Requests for Composite RateException 8 50  A3-3644  RDF-207.1 CWF doc  In-Facility Dialysis Bill Processing Procedures 8 50.1    RDF-207.1  A-03-33  Laboratory Services Included In the Composite Rate 8 50.2 A3-3168A       Drugs and Biologicals Included In the Composite Rate 8 50.3 RDF-320 Required Information for In-facilityClaims Paid Under the Composite Rate New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 50.3.1                                                                                              RDF-320.1 Submitting Corrected Bills8 50.4  A3-3644.2  Non-Required Items on the FormCMS-1450 for ESRD Bills 8 50.5  A3-3112.6  IPD in the Facility8 50.6 RDF-245.2D In-Facility Back-Up Dialysis8 50.6.1 A3-3644.1,A3-3171.1 Payment for In-Facility MaintenanceDialysis Sessions Furnished to CAPD/CCPD Home Dialysis Patients 8 50.6.2  A3-3644.1  Payment for Hemodialysis Sessions8 50.7 PRM1-2702.2 Ultrafiltration8 50.8 A3-3112.6D HO-E212.1HO-E212.2, HO-E212.3, HO-E212.4 PRM1-2707,PRM1-2707.1 Training and Retraining8 50.9 A3-3644.5   RDF-319.3    Coding for Adequacy of Hemodialysis 8 60 PRM1-2711 Separa tely Billable ESRD Items and Services 8 60.1 A3-3644.1,A3-3167.3  B3-4270.2  RDF-322  PRM1-2711.1 Lab Services8 60.2 A3-3644F1-A3-3644F5   B3-2231  RDF-319.1    Drugs Furnished in Dialysis Facilities New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 60.2.1                                                                            Billing Procedures for Drugs forFacilities 8 60.2.2 AB-99-63 Drug Payment Amounts for Facilities 8 60.2.3  A3-3644 AB-02-005 Use of Additional Codes by Facilities to Report Drugs 8 60.2.4  A3-3644E  RDF-319.4 Intravenous Iron Therapy8 60.2.4.1  A3-3644 Facility Billing Requirements to the Intermediary  8 60.2.4.2  B3-4461.1B3-4461.2 B3-4461.3 Physician Billing Requirements to theCarrier 8 60.3 A3-3644G1-A3-3644G3    PRM1-2711.3   Blood and Blood Services Furnished in Hospital Based and Independent Dialysis Facilities 8 60.4 A3-3644D1-D3,  B3-2049.3B1, B3-2049.5B RDF-319,RDF-207.5A-C,   PRM1-2710.3A-D AB-00-76, A-01-106, AB 97-2  EPO8 60.4.1  A3-3644 PRM1-2710.3 EPO Facility Billing Requirements Using UB-92/Form CMS-1450 8 60.4.2 B3-4273.1  EPO Supplier Billing Requirements (Method II) on the Form CMS-1500 8 60.4.2.1  B3-4273.1      Other Information Required on the Form CMS-1500 New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 60.4.2.2                                                                                                  B3-4273.2  Completion of Subsequent FormCMS-1500 Claims for EPO 8 60.4.3  A3-3644 Payment Amount8 60.4.3.1  A3-3644 Payment in Other Settings8 60.4.3.2 A-01-106 Hospital Outpatient Departments8 60.4.4 B3-4270.1  Home Patients8 60.4.4.1 B3-4270.1  Self Administered EPO Supply8 60.5 PRM1-2711.6 Intradia lytic Parenteral/Enteral Nutrition (IDPN) 8 60.6     PRM1-2711.4   Hepatitis B Vaccine Furnished to ESRD Patients 8 70 A3-3644A3-3169 B3-4270.1  PRM1-2706.1E,  PRM1-2706.2,  RO2 3440.2 Payment for Home Dialysis 8 70.1 B3-4271 PRM1-2740.2 Method Selection for Home DialysisPayment 8 70.1.1 PRM1-2740.2D Change in Method8 70.2 PRM1-2740.3 Prevention of Double Billing Under Method I and II 8 70.3 PRM1-2740.4 OverpaymentsNew  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8                                        80 A3-3644A,A3-3169,  B3-4270 B3-4271 RDF-318  PRM1-2710,PRM1-2710.4,  RO2 3440 Home Dialysis Method I Billing to the Intermediary 8 80.1 A3-3169.1    PRM1-2712   Items and Services Included in the Composite Rate for Home Dialysis 8 80.2  A3-3644 CWF doc.   General Intermediary Bill Processing Procedures for Method I Home Dialysis Services 8 80.2.1  A3-3644.2  Requi red Billing Information for Method I Claims 8 80.3  A3-3112.6  PRM1-2709,PRM1-2709.1A,  PRM1-2709.2,   Calculating Intermediary Payment for Intermittent Peritoneal Dialysis (IPD) for Method I 8 80.3.1 PRM1-2709.1B   IPD at Home for Method I Claims Submitted to the Intermediary 8 80.4  A3-3644.1  PRM1-2709.2 Calculating Payment for ContinuousAmbulatory Peritoneal  Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD) Under the Composite rate 8 90 A3-3644A,A3-3644.3  B3-4270, B3-4271, B3-4270.1, B3-4270.2, B3-4271   PRM1-2740  RO2 3440C Method II Billing  New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8                                                                                  90.1 A3-3170.6,A3-3644.3,  A3-3644.3A-E   B3-2231.3A &B, B3-2231,  B3-4270.1,  HO-238.2C HO-238.3, HO-238.3A PRM1-2709.2A    DMERC Denials for Beneficiary Submitted Claims Under Method II 8 90.2 B3-4270.1,B3-3045.7  Requirements For Payment by theDMERC 8 90.2.1 B3-4270.1  Supplier Documentation Required8 90.2.2 B3-4270.1  DMERC Letter Explaining Requirementsto Method II Supplier 8 90.3  B3-3045.7    B-01-56   Amount of Payment by the DMERC 8 90.3.1 B3-3045.7  Billing Instructions for Method II to DMERCs 8 90.3.2  B3-4270    B-01-56  Home Dialysis Supplies and Equipment HCPCS Codes Used to Bill the DMERC 8 90.3.3 B3-3045.7C DMERC Claims Processing Instructions8 90.4 Equipment and Equipment RelatedServices Provided to Direct Dealing Beneficiary 8 90.5 A3-3644.3C,A3-3644.3D  PRM1-2740.1,PRM1-2743.1    Method II Support Services Billed to the Intermediary by the Facility  8 90.5.1  A3-3644.3E, RDF-321 Billable UB-92 Revenue Codes Under Method II 8 90.5.1.1  A3-3644.3E Unbillable UB-92 Revenue Codes Under Method II New  Chap New  Sect Int.  Pub. 13 Carrier Pub. 14 HO 10 RDF 29 Provi der Reimburse Part 1 PMs Other Description 8 100  A3-3169.3