evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Round 2 Recompete of the DMEPOS CBP and National Mail Order (NMO) Recompete  10/03/2016  9579 R3565CP  07/20/2016 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP): Additional Instructions for the Implementation of Round 2 Recompete of the DMEPOS CBP and National Mail Order (NMO) Recompete  Rescinded and replace d by Transmittal 3593 10/03/2016  9579 Rev #  Issue Date  Subject  Impl Date  CR#  R3535CP  07/07/2016 Payment Change for Group 3 Complex Rehabilitative Power Wheelchairs Accessories and Seat and Back Cushions under Section 2 of the Patient Access and Medicare Protection Act (PAMPA)  07/05/2016  9520 R3500CP  04/28/2016 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP): Additional Instructions for the Implementation of Round 2 Recompete of the DMEPOS CBP and National Mail Order (NMO) Recompete  Rescinded and replace d by Transmittal 3565 10/03/2016  9579 R3493CP  04/14/2016 Payment Change for Group 3 Complex Rehabilitative Power Wheelchairs Accessories and Seat and Back Cushions under Section 2 of the Patient Access and Medicare Protection Act (PAMPA)  Rescinded and replaced by Transmittal 3535.  07/05/2016  9520 R3491CP  04/05/2016 Payment for Purchased Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Furnished to Medicare Beneficiaries Residing Outside the U.S. -  Expatriate Beneficiaries  07/05/2016  9468 R3459CP  02/05/2016 Payment Change for Group 3 Complex Rehabilitative Power Wheelchairs Accessories and Seat and Back Cushions under Section 2 of the Patient Access and Medicare Protection Act (PAMPA)  Rescinded and replaced by Transmittal 3493.  07/05/2016  9520 R3444CP  01/29/2016 Payment for Purchased Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Furnished to Medicare Beneficiaries Residing
(Medicare Claims Processing Manual)
07/05/2016  9520 R3444CP  01/29/2016 Payment for Purchased Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Furnished to Medicare Beneficiaries Residing Outside the U.S. -  Expatriate Beneficiaries  Rescinded and replaced by Transmittal 3491 07/05/2016  9468 Rev #  Issue Date  Subject  Impl Date  CR#  R3443CP  01/29/2016 Manual Update to Pub. 100- 04, Chapter 20, to Include Used Rental Equipment  07/05/2016  9488 R3416CP  11/23/2015 CY 2016 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule  01/04/2016  9431 R3196CP  02/13/2015 Payment Repairs to Capped Rental Equipment Prior to the End of the 13- Month Cap 07/06/2015  9062 R2993CP  07/25/2014 Update to Pub. 100- 04, Chapter 20 to Provide Language -Only Changes for Updating ICD -10 and ASC X12 08/25/2014  8694 R2977CP  06/20/2014 Clarification of Billing Instructions Related to the Home Health Benefit 09/23/2014  8775 R2687CP  04/19/2013 Clarify the Definition of Customized Durable Medical Equipment (DME) Items  07/19/2013  8194 R2629CP  01/04/2013 Updating the VMAP/4D Table with B5 Ocularist Specialty Code  02/05/2013  8123 R2605CP  11/30/2012 Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP)  01/07/2013  7836 R2511CP  08/03/2012 Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP)  Rescinded and replaced by Transmittal 2605 01/07/2013  7836 R2487CP  06/08/2012 Internet Only Manual (IOM) Update for Laboratory Services and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Claims Processed under the End Stage Renal Disease Prospective Payment System (ESRD PPS)  06/19/2012  7749 R2475CP
(Medicare Claims Processing Manual)
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Claims Processed under the End Stage Renal Disease Prospective Payment System (ESRD PPS)  06/19/2012  7749 R2475CP  05/18/2012 Internet Only Manual (IOM) Update for Laboratory Services and Durable Medical 06/19/2012  7749 Rev #  Issue Date  Subject  Impl Date  CR#  Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Claims Processed under the End Stage Renal Disease Prospective Payment System (ESRD PPS)  R2465CP  05/11/2012 Assigned Codes for Home Oxygen Use for Cluster Headaches (CH) in a Clinical Trial (ICD -10) 10/01/2012  7820 R2464CP  05/04/2012 Enhance the Multi -Carrier System (MCS) and ViPS  Medicare System (VMS) to Maintain Five Full Years of Pricing Data and to Automatically Price Claims/Adjustments at the Rates in Effect at the Dates of Service  10/01/2012 for VMS  7383 R2299CP  09/08/2011 Enhance the Multi -Carrier System (MCS) and ViPS Medicare System (VMS) to Maintain Five Full Years of Pricing Data and to Automatically Price Claims/Adjustments at the Rates in Effect at the Dates of Service  Rescinded and replaced by Transmittal 2464. 10/03/2011  7383 R2210CP  05/06/2011 Enhance the Multi -Carrier System (MCS) and ViPS Medicare System (VMS) to Maintain Five Full Years of Pricing Data and to Automatically Price Claims/Adjustments at the Rates in Effect at the Dates of Service  Rescinded and replaced by Transmittal 2299 10/03/2011  7383 R1961CP  04/30/2010 Payment for Replacement of Oxygen Equipment in Bankruptcy Situations  10/04/2010  6838 R1603CP  09/26/2008 Claims Jurisdiction and Enrollment Procedures for Suppliers of Certain Prosthetics, Durable Medical Equipment (DME) and Replacement Parts, Accessories and Supplies  10/27/2008  5917 R1493CP  04/18/2008 Establish Pre -Payment Auto- denial Edits in Applicable States for DMEPOS Suppliers of 04/07/2008  5929 Rev #  Issue Date  Subject  Impl Date  CR#  Oxygen and Oxygen Equipment (DME MACs only)
(Medicare Claims Processing Manual)
Establish Pre -Payment Auto- denial Edits in Applicable States for DMEPOS Suppliers of 04/07/2008  5929 Rev #  Issue Date  Subject  Impl Date  CR#  Oxygen and Oxygen Equipment (DME MACs only)  R1472CP  03/06/2008 Update of Institutional Claims References  04/07/2008  5893 R1421CP  01/25/2008 Update of Institutional Claims References -  Rescinded and Replaced by Transmittal 1472  04/07/2008  5893 R1378CP  11/23/2008 Establish Pre -Payment Auto- denial Edits in Applicable States for DMEPOS Suppliers of Oxygen and Oxygen Equipment (DME MACs only)  Replaced by Transmittal 1493  04/07/2008  5471 R1368CP  11/02/2007 Reporting an NPI and the EY Modifier on Claims for DMEPOS Items Dispensed Without a Physicians Order to Obtain a Medicare Denial for Coordination of Benefits (COB)  04/07/2008  5771 R1142CP  12/22/2006 DMERC Claim Modifiers for Upgrades  04/02/2007  5367 R961CP  05/26/2006 Home Use of Oxygen in Approved Clinical Trials  10/03/2006  4389 R867CP  02/17/2006 Elimination of the DMERC Information Form (DIF)  04/03/2006  4241 R863CP  02/17/2006 Update to Chapter 20, Billing for Oxygen and Oxygen Equipment, Section 130.6 03/17/2006  4271 R745CP  11/04/2005 Elimination of the DMERC Information Form (DIF)  04/03/2006  4040 R656CP  08/19/2005 Full Replacement of CR 3607, Payment Edits in Applicable States for DMEPOS Suppliers of Prosthetics and Certain Custom -Fabricated Orthotics, Change Request 3607 is Rescinded (DMERC Only)  10/03/2005  3959 R629CP  07/29/2005 Certificate of Medical Necessity Claim Edits Workload Reporting  01/03/2006  3699 Rev #  Issue Date  Subject  Impl Date  CR#  R546CP  04/29/2005 Number of DMEPOS Pricing Files That Must be Maintained Online for Medicare -DMERC, FI and RHHI Only
(Medicare Claims Processing Manual)
3699 Rev #  Issue Date  Subject  Impl Date  CR#  R546CP  04/29/2005 Number of DMEPOS Pricing Files That Must be Maintained Online for Medicare -DMERC, FI and RHHI Only 10/03/2005  3792 R489CP  03/04/2005 Correction to Healthcare Common Procedure Coding System (HCPCS) Code A4217 07/05/2005  3714 R445CP  01/21/2005 Payment to Providers/Suppliers Qualified to Bill Medicare for Prosthetics and Certain Custom Fabricated Orthotics  07/05/2005  3607 R330CP  10/22/2004 DMERC -Beneficiary Submitted Claims, Process First Claim 04/04/2005  3233 R329CP  10/22/2004 DMERC Only -Payment to Providers/Suppliers Qualified to Bill Medicare for Prosthetics and Certain Custom Fabricated Orthotics  07/05/2005  3373 R284CP  08/27/2004 DMERCs Only -Appeals of Duplicate Claims  09/27/2004  3371 R236CP  07/23/2004 2005 DMEPOS Pricing File Record Layout  01/03/2005  3300 R222CP  07/02/2004 Skilled Nursing Facility Consolidated Billing -New Requirements for Claims for DMEPOS  N/A 2453 R166CP  04/30/2004 New Systems Requirements  10/04/2004  2761 R001CP  10/01/2003 Initial Release of Manual  N/A N/A Back to top of chapter
(Medicare Claims Processing Manual)
Medicare Claims Processing Manual  Chapter 21 - Medicare Summary Notices   Table of Contents  (Rev. 11509, 07- 28-22) (Rev. 11510, 07- 28-22)    Transmittals for Chapter 21  10 - General Medicare Summary Notices (MSN) Requirements  10.1 -  General Requirements for the MSN  10.2 -  Correction/Reissuance of Faulty MSNs  10.3 -  A/B MAC (A), (B), (HHH), and DME MAC  Instructions for Preparing the MSN  10.3.1 -  Basic Concepts and Approaches  10.3.2 -  Format Conventions for the MSN  10.3.3 -  Specifications for Sectio n 1: Summary (Page 1)  10.3.4 -  Specifications for Header for Other Pages  10.3.5 -  Specifications for Section 2: Making the Most of Your Medicare (Page 2)  10.3.6 -  Specifi cations for Section 3: Claims  10.3.7 -  Claims Calculations  10.3.8 -  Specifications for Section 4 (Last Page): Denials and Appeals  10.3.9 -  Specifications for Pay MSN  Cover Sheet & Check  10.3.10 -  Specifications for Envelopes  10.3.11 -  Specifications for RRB Part B MSNs  10.3.12 -  Specifications for SSA Part B MSNs  10.3.13 -  Character Measurements for Fonts  20 - Specifications for Spanish MSN  20.1 -  Specifications for Content Variation of Spanish MSNs  30 - Exhibits  30.1 -  Exhibits of the Extended Family of MSNs in Black and White  30.2 -  Exhibits of Alternate Scenarios  30.3 -  Exhibits of MSNs in Spanish 30.4 -  Exhibits of the Extended Family of MSNs in Color  40 - General Information, Explanatory, and Denia l Messages  10 - General Medicare Summary Notices (MSN) Requirements  (Rev. 955, Issued: 05- 19-06, Effective: MCS -June 12, 2006, VMS -July 1, 2006, FISS -September 1, 2006, Implementation: MCS -June 12, 2006, VMS -July 3, 2006, FISS -September 1, 2006)   Effectiv e July 1, 2002, the MSN is used by all A/B MACs (A), (B), (HHH), and DME MACs.
(Medicare Claims Processing Manual)
Effectiv e July 1, 2002, the MSN is used by all A/B MACs (A), (B), (HHH), and DME MACs.   The MSN is the primary vehicle by which beneficiaries are notified of decisions on their claims for Medicare benefits.  The A/B MAC (A), (B), (HHH), or DME MAC mails a single M SN at the end of the month to each beneficiary for whom claim was processed during the month to inform the beneficiary of the disposition of all claims.  All MACs  shall issue No -Pay MSNs on a quarterly/90 day mailing cycle.  MSNs with checks to the beneficiary will continue to be mailed out as processed.  To ensure that all messages are uniform throughout the Medicare program, A/B MACs (A), (B), (HHH), and DME MACs may not use locally developed MSN messages until approved by the regional office (RO).   The MSNs are not sent to providers.  Providers receive remittance advice records.  (See Chapter 22 for instructions about the provider remittance record.)   The MSN contains the following sections or areas:    Disclaimer;   Title;  Claims Information;   Message; and   Appeals.   Detailed requirements for completion of each section are included in 10.3.  Generally, A/B MAC (A), (B), (HHH), or DME MAC requirements are the same.  Where there are differences or where the specific specification applies to only the A/B MAC (B)/DME MAC or to only the A/B MAC (A)/(HHH), the difference is noted in the specific instruction.  Although every attempt has been made to make the MSN as simple as possible, the MSN is sufficiently complex that MACs must maintain continuing training efforts directed at beneficiaries and providers for understanding and interpretation of data on the MSN.  Although providers are not mailed copies of MSNs, beneficiaries frequently show MSNs to providers to establish deductible status for provider billing.   10.1 - General Requirements for the MSN  (Rev. 1491, Issued: 04- 11-08, Effective: 05- 12-08, Implementation: 05- 12-08)
(Medicare Claims Processing Manual)
10.1 - General Requirements for the MSN  (Rev. 1491, Issued: 04- 11-08, Effective: 05- 12-08, Implementation: 05- 12-08)  A.  A/B MAC (A)/(HHH) MSN   The MSN is used to notify Medicare beneficiaries of action taken on A/B MAC (A)/(HHH) processed claims.  MSNs are not used by A/B MACs (HHH) for RAPs, and RAP data are not included on the monthly MSN.  The MSN provides the beneficiary with a record of services received and the status of any deductibles.  The MSN also informs the beneficiary of appeal rights.  The Balanced Budget Act of 1997 requires all Part A benefit notices to include the amount of Medicare payment for each service.  A/B M ACs (A) and (HHH), must furnish an MSN to all beneficiaries for whom claims are filed during the month unless the situation is specifically excluded by other manual instructions.  MACs  shall issue No -Pay MSNs on a quarterly/90 day mailing cycle.  MSNs with  a payment check to the beneficiary shall continue to be mailed out as processed.  No- pay MSNs are defined as those MSNs which do not require payment to the beneficiary for the respective claim(s).   The MSN replaced the following documents:    Form CMS -1533, Part A Medicare Benefit Notice, also known as the Part A Notice of Utilization (NOU) sent for inpatient services;   Form CMS -1954, Benefit Denial Letter (BDL), sent for partially denied claims; and    Form CMS -1955, BDL sent for totally denied claims.  Since CMS eliminated BDLs, Medicare beneficiaries receive the information previously conveyed on BDLs through narrative messages contained on the MSN.  Providers no longer receive a separate written notification or copy of the BDL.  Providers must utilize the coding information (e.g., ANSI Reason Codes) conveyed on the financial remittance advice to ascertain reasons associated with Medicare claims determinations affecting payment and applicable appeal rights and/or appeals information.  B.  A/B MAC (B)/DME MAC MSN
(Medicare Claims Processing Manual)
The MSN is used to notify Medicare beneficiaries of action taken on their processed claims.  The MSN provides the beneficiary with a record of services received and the status of any deductibles.  The MSN also informs the beneficiary of appeal rights .  10.2 - Correction/Reissuance of Faulty MSNs (Rev. 159, 04- 30-04)  Occasionally programming errors will occur which cause inaccuracies on MSNs that do not materially affect benefits.  An example of a potential programming error could be one data column w riting in another data column.  So long as the claims are correctly paid and the notice is intelligible, it is not necessary to identify the impacted MSNs or reissue them.  The resources to identify and reissue all of the documents would not be justified.  In situations where MACs feel reissuance is absolutely necessary, they must work with their regional office to identify costs involved before proceeding.  When such problems occur, MACs must take actions that will inform beneficiaries of the situation.  T hese actions should fall within the framework of routine operations.  Such actions include, but are not limited to, fielding calls from beneficiaries and alerting customer service representatives of the situation  and posting an alert on MACs Web sites.  W hile not all of these solutions may be possible, MACs should take the most appropriate steps to best mitigate the potential confusion, but not incur special costs.  Any communication regarding this type of situation should convey that it was a temporary pr ogramming error, which has been fixed, and is believed not to have affected the beneficiarys benefits.   A beneficiary may call the MAC to request a copy of the MSN with the correct information.  In such cases, the MAC will provide one.  10.3 - A/B MAC (A) , (B), (HHH), or DME MAC Instructions for Preparing the MSN  (Rev. 1, 10- 01-03) PM A -99-48  10.3.1 - Basic Concepts and Approaches  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  A. Overview
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10.3.1 - Basic Concepts and Approaches  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  A. Overview   The Medicare Summary Notice (MSN) is a  printed notification, sent to Medicare beneficiaries enrolled in Original Medicare, that displays data for claims processed during a given reporting period.  The MSN lists claim information in a summarized format.  It also contains other helpful infor mation for beneficiaries.  Each MSN consists of the following four sections:   SECTION 1: SUMMARY (PAGE 1)  A one -page summary of the beneficiarys Medicare status and of the claims data on the notice.   SECTION 2: MAKING THE MOST OF YOUR MEDICARE (PAGE 2)  One page with tips for beneficiaries on how to use their MSN, get help with Medicare issues, and learn more about Medicare services.   SECTION 3: CLAIMS (PAGE 3 -  X) A section, which may extend over multiple pages, listing the beneficiary claims submitted to  Medicare over the period of the notice.   SECTION 4: DENIALS & APPEALS (LAST PAGE)  One page containing details on beneficiaries appeals rights and, more generally, on how they can get help with denied claims.   Layout and content specifications for these s ections begin at 10.3.4.  Specifications address the position, formatting, content, and (if applicable) rules for dynamic content in individual subsections of each section.  B. Claim Types: The Extended Family of MSNs   Medicare claims are processed and paid under a range of different systems.  (In addition, different claim types may be processed and printed by separate MACs.)  While the overall appearance and format of all MSNs is consistent, different claim types do require some variations in the notice , in both the type of content supplied and the specific language used.   This document identifies eight  primary claim types  in the extended family of MSNs:   GLOBAL NOTICE:  This file version does not include specifications for Part A claims for inpatient mental health care in a psychiatric hospital.  The instructions for these claims will be included in a subsequent version.    Part A Inpatient  Claims for inpatient hospital services and skilled -nursing facility services.
(Medicare Claims Processing Manual)
 B of A Claims for outpatient services provided by medical facilities; these claims are paid under the Part B program, but their claim data is presented in a format similar to Part A Inpatient claims.    Hospice  Claims for hospice care, which are paid for under Part A but require a claim  format more similar to Part B claims.    Home Health  Claims for home -health services that are paid under Part A or Part B.  These MSNs also require a claim format more similar to Part B claims.    Part B, unassigned  Claims for Part B medical services from pro viders that do not accept Medicare assignment; payment for unassigned claims may be made directly to beneficiaries, which affects the format of claims data on the MSN.    DME, assigned  Claims for durable medical equipment (DME) and related services from suppliers that accept Medicare assignment.    DME, unassigned  Claims for DME from suppliers that do not accept Medicare assignment; payment for unassigned claims may be made directly to beneficiaries, which affects the format of claims data on the MSN.   COMBINED MSNs   In some instances, multiple claim types may be combined on a single MSN.  This most commonly occurs with Part A Inpatient and B of A claims, with Part B assigned and unassigned claims, and with DME assigned and unassigned claims.  Instructions related to combined MSNs will be found below in any section or subsection that is affected.   PAY MSNs   From time to time, beneficiaries may receive an MSN that includes a check, refunding an overpayment made (most often) for Part B services, either assigne d or unassigned.  Instructions related to Pay MSNs will be found below in any section or subsection that is affected.  Instructions for the check cover sheet are located near the rear of this chapter.  Instructions for Pay MSN envelopes are located in the Envelopes section. In addition, there are examples of complete Pay MSNs in the Exhibits section.   EFFECT OF CLAIM TYPES   In the specifications below, layout and content instructions can be assumed to be global -  that is, they apply to all MSNs, regardless of what types of claims appear on the notice.
(Medicare Claims Processing Manual)
EFFECT OF CLAIM TYPES   In the specifications below, layout and content instructions can be assumed to be global -  that is, they apply to all MSNs, regardless of what types of claims appear on the notice.   However, there are particular sections and subsections of the MSN where the type of claims on the MSN determines not only what specific claim data is printed, but also affects the inclusion of other content and language across the notice.   If a given subsection is affected by the claim type(s) on the notice, specifications for that subsection will be split -  into global specifications and specifications for each member of the extended family.   10.3.2 - Format C onventions for the MSN  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  This information describes the overall format conventions for the MSN.   MSNs are a combination of fixed and variable length sections, using a range of dif ferent typefaces and type styles, as well as a number of static graphic elements.  For discussion of the display in specific areas of the notice, see the technical specifications beginning in section 10.3.3. MACs should establish page layout and page breaks as specified by these instructions and exhibits.   A. Printing Requirements   MSN MACs must follow these instructions:   Generate all MSN forms by a laser printer.   Ensure that the MSN is printed on 8.5 by 11 inch paper, exclusive of perforated marginal pin -feed tabs.   Print duplex.   Use black ink only on white paper.   Use shading as required by the instructions and exhibits.   Allow for coding necessary for mail sorting equipment (e.g., bar coding, aims marks).   Ensure any MACs notations placed on the MSN do not affect the design of the MSN.   Refer to the specifications and exhibits for placement of information on the MSN.  B. Page Margins and Layout   Use 0.5- inch outer margins on the notice with exceptions when noted in the instructions. Alternate approved margins, 0.75- inch left and 0.25- inch right, may also be used when extra space is needed for bar code placement.