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Chapter 7 Medicare Benefit Policy Manual

Where Can I Access The Medicare Benefit Policy Manual

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The Medicare Benefit Policy Manual is available online for free on CMS.gov, the official government website for the Centers for Medicare & Medicaid Services. There is no need to download anything. You can simply click on the chapter you wish to view.

Each chapter is available as a separate PDF, which makes it easier to skip directly to the information you are seeking. Keep in mind that some of the chapters are very long. For example, chapter 7 contains 106 pages. However, there is a table of contents at the beginning of the chapter that can help you find the correct page for your specific need.

If you are a current or future Medicare beneficiary, the manual that may be more helpful to you is the Medicare & You handbook, which is published every year and distributed to Medicare beneficiaries. This handbook contains information related to the patient side of Medicare and is a helpful resource for anyone who is on Medicare or will be soon.

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Transcription Of Medicare Benefit Policy Manual

1MedicareBenefitPolicyManualchapter 7 – Home Health Services Table of Contents Transmittals for chapter 7 10 – Home Health Prospective Payment System – National 60-Day Episode Rate – Adjustments to the 60-Day Episode Rates – Continuous 60-Day Episode Recertification – Counting 60-Day Episodes – Split Percentage Payment Approach to the 60-Day Episode – Physician Signature Requirements for the Split Percentage Payments – Low Utilization Payment Adjustment – Partial Episode Payment Adjustment – Outlier Payments – Discharge Issues – Consolidated Billing – Change of Ownership Relationship to Episodes Under PPS 20 – Conditions To Be Met for Coverage of Home Health Services – Reasonable and Necessary Services – Background – Determination of Coverage – Impact of Other Available Caregivers and Other Available Coverage on Medicare Coverage of Home Health Services – Use of Utilization Screens and “Rules of Thumb” 30 – Conditions Patient Must Meet to Qualify for Coverage of Home Health Services – Confined to the Home – Patient Confined to the Home – Patient’s Place of

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Who Is The Medicare Benefit Policy Manual For

The Medicare Benefit Policy Manual is one of several internet-only manuals published by the U.S. Centers for Medicare & Medicaid Services, or CMS.

Health care providers, contractors, Medicare Advantage companies and state survey agencies use the Benefit Policy Manual and other publications as a guide to administer Medicare coverage.

The manual includes detailed information regarding day-to-day operating instructions, policies and procedures, all of which are based on government statutes, regulations, guidelines and directives.

While the manual is intended for health care professionals, it can also serve as a rich source of information for members of the general public and Medicare beneficiaries.

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    Update To Chapter 7 ‘home Health Services’ Of The Medicare Benefit Policy Manual

    In this article, youll learn about: updates to chapter 7 of the Medicare Benefit Policy Manual to incorporate Calendar Year 2022s Policy Implementation of the Notice of Admission the elimination of the Request for Anticipated Payment policy and the corrections and clarifications regarding who may sign the certification and recertification for home health people with Medicare.

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    What Are The Most Important Chapters

    The Medicare Benefit Policy Manual comprises 17 chapters and covers program guidelines for multiple health care settings.

    Hospitals, doctors offices, rehabilitation clinics, skilled nursing facilities, home health care companies and others use this information to navigate complex Medicare rules.

    The manual largely focuses on the Medicare Part A benefit, with chapters on inpatient hospital coverage, skilled nursing facilities, hospice care, ambulance services, lifetime reserve days, inpatient psychiatric care and home health services.

    Theres also guidance on more specific topics, including end-stage renal disease, medical devices and coverage exclusions.

    Chapter 17 is the manuals newest addition. It covers opioid treatment programs.

    Medicare Benefit Policy Manual Chapters

    Medicare rules and regulation are specific to each practice setting. Providers should consult the chapter that corresponds to their health care facilities.

    For example, Chapter 7 is specific to home health services covered under Medicare Part A. If a home health care agency provides services under Part B, they should refer to chapter 15, which governs all outpatient therapy services.

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    Medicare Benefit Policy Manual Chapter 7

    Transcription

    1 Medicare Benefit Policy Manual Chapter 7 – Home Health Services Transmittals for Chapter 7 Table of Contents 10 – Home Health Prospective Payment System National 60-Day Episode Rate Adjustments to the 60-Day Episode Rates Continuous 60-Day Episode Recertification Counting 60-Day Episodes Split Percentage Payment Approach to the 60-Day Episode Physician Signature Requirements for the Split Percentage Payments Low Utilization Payment Adjustment Partial Episode Payment Adjustment Outlier Payments Discharge Issues Consolidated Billing Change of Ownership Relationship to Episodes Under PPS 20 – Conditions To Be Met for Coverage of Home Health Services Reasonable and Necessary Services Background Determination of Coverage Impact of Other Available Caregivers and Other Available Coverage on Medicare Coverage of Home Health Services Use of Utilization Screens and “Rules of Thumb” 30 – Conditions Patient Must Meet to Qualify for Coverage of Home Health Services Confined to the Home Patient Confined to the Home Patient’s Place of Residence Services Are Provided Under a Plan of Care Established and Approved by a Physician

    What Does The Medicare Benefit Policy Manual Include

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    The Medicare Benefit Policy Manual covers program guidelines for hospitals, doctors offices, rehabilitation clinics, skilled nursing facilities, home health care companies and other health care providers who treat Medicare patients and accept Medicare coverage.

    The manual also includes information for private insurance companies who sell Medicare Advantage plans, Medicare Part D prescription drug plans and Medicare Supplement Insurance plans related to how Medicare plan benefits may and may not be covered, packaged, marketed, sold and administered.

    The manual mostly focuses on Medicare Part A, which covers hospital benefits and other inpatient care. There is also information about more specific topics like end-stage renal disease, opioid treatment programs, medical equipment and devices and coverage exclusions and exceptions.

    There are 17 chapters in the manual:

  • Inpatient Hospital Services Covered Under Part A
  • Inpatient Psychiatric Hospital Services
  • Duration of Covered Inpatient Services
  • Inpatient Psychiatric Benefit Days Reduction and Lifetime Limitation
  • Lifetime Reserve Days
  • Hospital Services Covered Under Part B
  • Home Health Services
  • Coverage of Extended Care Services Under Hospital Insurance
  • Coverage of Hospice Services Under Hospital Insurance
  • Ambulance Services
  • Comprehensive Outpatient Rehabilitation Facility Coverage
  • Rural Health Clinic and Federally Qualified Health Center Services
  • Medical Devices
  • Covered Medical and Other Health Services
  • Opioid Treatment Programs
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    Where Can I Find The Medicare Benefits Policy Manual

    The Medicare Benefit Policy Manual is available on the CMS website.

    The manual isnt a single document. Rather, each chapter is a separate, hyperlinked PDF.

    for a full list of all the chapters.

    For a list of all CMS internet-only manuals, including National Coverage Determinations and the claims processing manual, .

    New Medicare beneficiaries and their families may find the Medicare & You Handbook more informative and user-friendly than the Medicare Benefit Policy Manual. This comprehensive guide to coverage, benefits and enrollment is updated annually and highlights new policy changes at the beginning of the document.

    What Is The Medicare Benefit Policy Manual Used For

    While the Medicare Benefit Policy Manual has some use to Medicare beneficiaries and to general members of the public, the document is most often primarily used by health care professionals.

    The manual includes information related to day-to-day Medicare operating instructions, policies and procedures, government statutes, regulations, guidelines and directives that all combine to shape how Medicare coverage is administered to millions of Americans.

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