(Medicare Claims Processing Manual)

Medicare Claims Processing Manual  Chapter 1 - General Billing Requirements   Table of Contents  (Rev. 1 2448, Issued: 01 -11-24)    Transmittals for Chapter 1   01 - Foreword  01.1 - Remittance Advice Coding Used in this Manual  02 - Formats for Submitting Claims to Medicare  02.1 - Electronic Submission Requirements  02.1.1 - HIPAA Standards for Claims  02.1.2 - Where to Purchase HIPAA Standard Implementation Guides  02.2 - Paper Claims  02.2.1 - Paper Formats for Institutional Claims  02.2.2 - Paper Formats for Professional and Supplier Claims  02.3 - Remittance Advices  10 - Jurisdiction for Claims  10.1 - A/B MACs (Part B) and DME MACs Jurisdiction of Requests for Payment  10.1.1 - Payment Jurisdictions Among A/B MACs (B) for Services Paid Under the Physician Fee Schedule and Anesthesia Services  10.1.1.1 - Claims Processing Instructions for Payment Jurisdiction  10.1.1.2 - Payment Jurisdiction for Services Subject to the Anti-Markup Payment Limitatio n 10.1.1.3 - Payment Jurisdiction for Reassigned Services  10.1.3 - Exceptions to Jurisdictional Payment  10.1.5 - Domestic Claims Processing Jurisdictions  10.1.5.1 - Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, Supplies, Parental and Enteral Nutrition (PEN)  10.1.5.2 - Supplier of Portable X- Ray, EKG, or Similar Portable Services  10.1.5.3 - Ambulance Services Submitted to Carriers  10.1.5.4 - Independent Laboratories  10.1.5.4.1 - Cases Involving Referral Laboratory Services  10.1.6 - Railroad Retirement Beneficiary Carrier  10.1.7 - Welfare Carriers  10.1.9 - Disposition of Misdirected Claims to the B/MAC/ Carrier /DME MAC  10.1.9.1 -  An A/B MAC (B) Receives a Claim for Services that are in Another A/B MAC (B)s Payment Jurisdiction 10.1.9.2  An A/B MAC (B) Receives a Claim for Services that are in a DME MACs Payment Jurisdiction  10.1.9.3  A DME MAC Receives a Claim for Services that are in A Local B/MAC/Carriers Payment Jurisdiction  10.1.9.4 -  An A/B MAC (B) Receives a Claim for an RRB Beneficiary  10.1.9.5 -  An A/B MAC (B) or DME MAC Receives a Claim for a UMWA Beneficiary  10.1.9.6 -  Medicare Carrier or RRB -Named Carrier to Welfare Carrier  10.1.9.7 -  Protests Concerning Transfer of Requests for Payment to Carrier  10.1.9.8 -  Transfer of Claims Material Between Carrier and Intermediary (FI) 10.1.9.9 -  A DME MAC receives a Paper Claim with Items or Services that are in Another DME MAC's Payment Jurisdiction 10.2 -  FI Jurisdiction of Requests for Payment  10.2.1 -  FI Payment for Emergency and Foreign Hospital Services  10.3 -  Payments Under Part B for Services Furnished by Suppliers of Services to Patients of a Provider  10.4 -  Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody Under a Penal Authority 10.5  Claims Processing Requirements for Deported Beneficiaries  10.5.1  Implementation of Payment Policy for Deported Beneficiaries  20 - Provider Assignment to FIs and MACs  20.1 -  FI Service to HHAs and Hospices  20.2 -  Provider Change of Ownership (CHOW)  20.3 -  CMS No Longer Accepts Provider Requests to Change Their FI  30 - Provider Participation  30.1 -  Content and Terms of Provider Participation Agreements  30.1.1 -  Provider Charges to Beneficiaries  30.1.1.1 -  Charges to Hold a Bed During SNF Absence  30.1.2 -  Provider Refunds to Beneficiaries  30.1.3 -  Provider Treatment of Beneficiaries  30.2 -  Assignment of Providers Right to Payment  30.2.1 -  Exceptions to Assignment of Providers Right to Payment -  Claims Submitted to A/B MACs  30.2.2 -  Background and Purpose of Reassignment Rules -  Claims Submitted to B/MACs  30.2.2.1 -  Reassignments by Nonphysician Suppliers -  Claims Submitted to FIs  30.2.3 - Effect of Payment to Ineligible Recipient  30.2.4 - Payment to Agent - Claims Submitted to Carriers  30.2.5 - Payment to Bank 30.2.6 - Payment to Employer of Physician - Carrier Claims Only  30.2.7 - Payment for Services Provided Under a Contractual Arrangement - Carrier Claims Only  30.2.8.2 - University -Affiliated Medical Faculty Practice Plans  - Claims Submitted to Carriers  30.2.8.3 - Indirect Payment Procedure (IPP) - Payment to Entities that Provide Coverage Complementary to Medicare Part B  30.2.9 - Payment to Physician or Other Supplier for Purchased Diagnostic Tests Subject to the Anti- Markup Payment Limitation -Claims Submitted to A/B MACs  (Part B)  30.2.10 -  Payment Under Reciprocal Billing Arrangements - Claims Submitted to A/B MACs Part B  30.2.11 -  Payment Under Fee -For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements) - Claims Submitted to A/B MACs Part B