Frequently Asked Questions

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Top Questions


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)

In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorde...
Yes. The Introductory material to the DSM-IV and DSM-5 code set indicates that the DSM-IV and DSM-5 are “ compatible”... (more)

Where can I find the ICD-10 code sets?
... (more)

[EHR Incentive Programs] A number of measures for Meaningful Use objectives for eligible hospitals and crit...
There are two methods for calculating ED admissions for the denominators for measures associated with Meaningful Use ... (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 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)

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

[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)

[EHR Incentive Programs]  When reporting on the Summary of Care objective in the Electronic Health Rec...
A transition of care is defined as the movement of a patient from one setting of care (hospital, ambulatory, primary ... (more)

[EHR Incentive Programs] For Stage 1 and 2 meaningful use objectives of the Medicare and Medicaid Electroni...
The Stage 2 Final Rule (CMS-0044-F) changed the way shared Certified EHR Technologies are handled for testing, regist... (more)

How do I know if I have a PECOS Record?
There are three (3) ways to verify that you have an enrollment record in PECOS: Check the O... (more)

[EHR Incentive Programs]  For meaningful use Stage 2's transitions of care and referrals objective, in...
An EP, eligible hospital, or CAH could use 3 distinct approaches (which could also be used in combination) to meet th... (more)

[EHR Incentive Programs]  Does the inclusion of certified Medical Assistant in the list of professiona...
We have revised the description of who can enter orders into the EHR and have it count as CPOE and have it count for pur... (more)

What is the definition of "new patient" for billing evaluation and management (E/M) services?
Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation an... (more)

[EHR Incentive Programs]  In calculating the meaningful use objectives requiring patient action, if a ...
Yes.  This transitive effect applies to the Secure Messaging and the 2nd measure of the Patient Access (View, Do... (more)

[EHR Incentive Programs]  Can an eligible professional (EP) or hospital charge patients a fee to have ...
We do not believe it would be appropriate for the EP or hospital to charge the patient a fee to access the Certified ... (more)

[EHR Incentive Programs]  When meeting the meaningful use measure for “secure messaging” in the Electr...
As part of this objective, the eligible professional (EP) must make available to patients a secure messaging option c... (more)

[EHR Incentive Programs] If an eligible professional (EP) sees a patient in a setting that does not have ce...
Starting in 2013, an EP must have access to Certified EHR Technology at a location in order to include patients seen ... (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] 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)

[EHR Incentive Programs]  If an eligible provider fails to meet meaningful use (MU) during a participa...
An Eligible Professional (EP), Eligible Hospital or Critical Access Hospital (CAH) that participates in the Medicare ... (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)

[EHR Incentive Programs] Is the physician the only person who can enter information in the electronic healt...
No. The Final Rule for the Medicare and Medicaid EHR incentive programs, specifies that in order to meet the meaningful ... (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)

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]  When meeting the meaningful use measure for computerized provider order entr...
If a staff member of the eligible provider is appropriately credentialed and performs similar assistive services as a... (more)

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

How do consumers apply for coverage and enroll in a health plan through the Health Insurance Marketplace?
Consumers can file a marketplace application online, by phone through a toll-free call center, by mail or in per... (more)

[EHR Incentive Programs]  For the Stage 2 meaningful use objective of the Medicare and Medicaid Electr...
The Stage 2 Final Rule (CMS-0044-F) changed the way shared Certified EHR Technologies are handled for the Stage 2 mea... (more)

How do I report ICD-10 codes on claims when the dates of service span from prior to 10/1/2014 to on or afte...
Many payers are requiring claims with dates of service that span the October 1, 2014 implementation date to be split ... (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)

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)

How should eligible professionals (EPs) select menu objectives for the Medicare and Medicaid Electronic Hea...
EPs participating in Stage 1 of the EHR Incentive Programs are required to report on a total of 5 meaningful use obje... (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)

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] Can a hospital count a patient toward the measures of the “Patient Electronic Acce...
The 2nd measure of the “Patient Electronic Access” core objective for hospitals and critical access hospitals (CAH) r... (more)

[EHR Incentive Programs] For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, h...
The CPOE measure is structured to minimize reporting burden.  However, if all of the following conditions a... (more)

Where can I find a list of procedures and ancillary services that are payable in the Ambulatory Surgical Ce...
ASC covered surgical procedures and associated payment rates are published in Addendum AA of the hospital outpatient pro... (more)

For the Medicare and Medicaid EHR Incentive Programs, how does an eligible professional (EP) determine whet...
All cases where the EP and the patient have an actual physical encounter with the patient in which they render any servi... (more)

How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit ...
For MUEs ... (more)

[EHR Incentive Program]  Does CMS require specific kind of credential or a specific organization for m...
CMS does not specify credentialing organizations that would qualify medical assistants under this definition. Medical as... (more)

For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, should patient encounters ...
Yes. EPs who practice in multiple locations must have 50 percent or more of their patient encounters during the reportin... (more)

Does the Physician Quality Reporting System (PQRS) 0% performance rule apply to reporting during the 2013 P...
The PQRS 0% performance rule only applies to satisfactory reporting for 2013 PQRS incentive eligibility. The 0% performa... (more)

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)

[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)

[EHR Incentive Programs]  What is the deadline for eligible professionals (EP) to submit attestations ...
EPs participate in the EHR Incentive Programs on the calendar year, which is January 1 to December 31. The attestatio... (more)

[EHR Incentive Programs] To meet the Stage 1 public health meaningful use objectives for the Medicare ...
CMS recognizes that there are a variety of methods in which the exchange of public health information could take place. ... (more)

[EHR Incentive Programs]  For some of the eligible professional (EP) clinical quality measures (CQMs),...
CQMs that include look back periods or look forward periods may require data outside of the reporting period of a CMS... (more)

[EHR Incentive Programs]  While the denominator for measures used to calculate meaningful use in the M...
The criteria for a numerator is not constrained to the EHR reporting period unless expressly stated in the numerator ... (more)