Frequently Asked Questions


Top Questions

How is the Therapy Progress Report different than the Treatment Encounter Note and what information should ...
The Progress Report provides justification for the medical necessity of treatment. For Medicare payment purposes, inform... (more)

What is Revalidation?
Revalidation is the process by which CMS or its contractor requires a provider or supplier to certify the accuracy of th... (more)

How do I obtain the Correct Coding Initiative (CCI) Edits Manual?
The Correct Coding Initiative (CCI) Edits Manual may be obtained in two ways. The first is through the CMS website at ... (more)

What does the physician referral law prohibit?
The physician referral law (section 1877 of the Social Security Act) prohibits a physician from referring patients to an... (more)

[EHR Incentive Programs] How and when will incentive payments for the Medicare Electronic Health Record (EH...
For eligible professionals (EPs), incentive payments for the Medicare EHR Incentive Program will be made approximatel... (more)

How can a health care provider apply for and obtain a National Provider Identifier (NPI)?
A health care provider may apply for an NPI in one of three ways: 1. Apply through a web-based application ... (more)

What is CMS?
The Centers for Medicare & Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. ... (more)

What are Therapy Caps?
Therapy caps are congressionally-mandated financial limitations on outpatient occupational therapy, physical therapy, an... (more)

When are providers and suppliers required to revalidate?
Providers and suppliers, including physicians, are required to revalidate their information every five years, while cert... (more)

How do physicians join or leave a group?
If both the physician and the group are already enrolled with the same carrier, the physician and the group together are... (more)

Why do I have to pay a Medicare enrollment application fee?
Section 6401(a) of the Affordable Care Act (ACA) requires the Secretary to impose a fee on each "institutional provid... (more)

[EHR Incentive Programs] When eligible professionals work at more than one clinical site of practice, are t...
CMS considers these two separate, but related issues.Meaningful use: Any eligible professional demonstrating mean... (more)

I recently hired a new office manager. In addition, we will be moving next week. Should I submit that infor...
There have been no changes to Medicare enrollment update filing timelines. Providers and suppliers should continue to su... (more)

What simple steps can I take to submit Physician Quality Reporting System (PQRI) quality measures data on c...
Take the following steps to begin claims-based reporting for Physician Quality Reporting: 1). Use the measure specificat... (more)

Who is the Administrator and what is the mailing address?
For the latest information, please visit: ... (more)

What is the mutually exclusive edit table?
The mutually exclusive edit table contains edits consisting of two codes (procedures) which cannot reasonably be perform... (more)

[EHR Incentive Programs] For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, i...
In most cases, an eligible professional or eligible hospital is not limited to demonstrating meaningful use to the ex... (more)

[EHR Incentive Programs] Who can enter medication orders in order to meet the measure for the computerized ...
Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the... (more)

[EHR Incentive Programs] What do the numerators and denominators mean in measures that are required to demo...
There are 15 measures for EPs and 14 measures for eligible hospitals that require the collection of data to calculate a ... (more)

What hard-copy documentation must accompany the revalidation enrollment application?
The documents that must accompany the 855 enrollment application or the internet based PECOS application form are specif... (more)

[EHR Incentive Programs] In order to receive payments under the Medicare and Medicaid Electronic Health Rec...
In order to receive Medicare EHR incentive payments, EPs, eligible hospitals, and critical access hospitals must have... (more)

[EHR Incentive Program] I am an eligible professional (EP) who has successfully attested for the Medicare E...
For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks aft... (more)

What is an IRS Form CP 575?
The IRS Form CP 575 is an Internal Revenue Service generated letter you receive from the IRS granting your Employer Iden... (more)

How do you make changes to the provider enrollment information on file with your fee-for-service contractor?
Providers and suppliers should report changes using the applicable provider enrollment application (CMS-855) for your pr... (more)

Who is affected by the transition to ICD-10? If I don't deal with Medicare claims, will I have to transition?
Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition to ICD-10. &nbs... (more)

If I am joining a Group, will I need to submit the Group’s National Provider Identifier (NPI) in section 4B...
In Section 4B of the CMS-855I, the NPI of the Group should be entered if it has been issued to the Group. If you are jo... (more)

What are the hours and contact information for the HETS Help Desk?
The operational hours for the MCARE Help Desk have changed.  Effective February 1, 2012 the Help Desk ... (more)

If an eligible professional (EP) is unable to meet the measure of a Meaningful Use objective because it is ...
Some Meaningful Use objectives provide exclusions and others do not. Exclusions are available only when our regulations ... (more)

[EHR Incentive Programs] What information must an eligible professional provide in order to meet the measur...
In our final rule, we defined "clinical summary" as: an after-visit summary that provides a patient with relevant and ac... (more)

Can you explain the term 'skilled service?'
Skilled services covered by the Medicare home health benefit are discussed in the Home Health Manual, CMS Publication 11... (more)

[EHR Incentive Programs] My practice does not typically collect information on any of the core, alternate c...
EPs are not excluded from reporting clinical quality measures, but zero is an acceptable value for the CQM denominato... (more)

Can I fax a copy of the provider enrollment application to the Medicare contractor?
No. Since the enrollment application must contain an original signature, you cannot fax an enrollment application to a ... (more)

[EHR Incentive Programs]  For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Progr...
The attestation system only allows the selection of 5 menu objectives. If an EP practices in multiple locations that ... (more)

[EHR Incentive Programs] After successfully demonstrating meaningful use for the Medicare and Medicaid Elec...
Eligible professionals (EPs) participating in the Medicare EHR Incentive Program will receive a single lump sum payme... (more)

[EHR Incentive Programs] Do specialty providers have to meet all of the meaningful use objectives for ...
For eligible professionals (EPs) who participate in the Medicare and Medicaid EHR Incentive Programs, there are a tot... (more)

I recently enrolled in Medicare. Am I going to have to complete revalidation paperwork?
Even if you recently enrolled, you may receive a request to revalidate your enrollment, since there are number of reason... (more)

[EHR Incentive Programs]  To meet the third measure of the objective of providing “a summary of care r...
If a summary of care record used for an actual transition of care or referral is electronically exchanged with a recipie... (more)

For eligible professionals (EPs) who see patients in both inpatient and outpatient settings (e.g., hospital...
In this case, EPs should base both the numerators and denominators for meaningful use objectives on the number of unique... (more)

[EHR Incentive Programs] For the meaningful use objective of "capability to exchange key clinical informati...
For the purposes of the "capability to exchange key clinical information" measure, exchange is defined as electronic tra... (more)

[EHR Incentive Programs] If an eligible professional (EP) in the Medicaid EHR Incentive Program wants to le...
EPs may use a clinic or group practice's patient volume as a proxy for their own under three conditions:(1) T... (more)

How were Medically Unlikely Edits (MUEs) developed?
MUEs were developed based on Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) code... (more)

To whom does the revalidation effort apply?
The Medicare enrollment revalidation effort over the next four years applies to all practitioners. Through the end of 20... (more)

We are concerned that we will not receive the revalidation requests that are mailed to the provider by the ...
A list of providers and suppliers who have been sent requests to revalidate their Medicare enrollment is available at... (more)

What are the financial benefits of participation in the Physician Quality Reporting System (Physician Quali...
A Physician Quality Reporting participant who reports satisfactorily will earn a financial incentive based on a percenta... (more)

What's the difference between the Outpatient Code Editor edits and the CCI edits?
The OCE edits and the CCI edits are two editing systems used to process fiscal intermediary (hospital outpatient) and ca... (more)

With respect to the site visit, how can we determine which screening category we are in ? How do we know if...
Beginning on March 25, 2011, Medicare will place newly-enrolling and existing providers and suppliers in one of three... (more)

[EHR Incentive Program]  Will the Centers for Medicare & Medicaid Services (CMS) conduct audits as...
Any provider attesting to receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program ... (more)

Can you please provide the reference link that identifies those providers and suppliers who will be deemed ...
The following links you directly to the article which addresses the ACA related enrollment changes: ... (more)

Where can I find the latest average sales price (ASP) Medicare Part B payment files?
The payment file for the Medicare Part B drugs is updated quarterly and can be found on the CMS Average Sales Price (ASP... (more)

[EHR Incentive Programs] For meaningful use objectives of the Medicare and Medicaid Electronic Health Recor...
No, if multiple EPs are using the same certified EHR technology in different physical locations/settings (e.g., differen... (more)