Medicare Web site provides an informational gold mine

It is hard to imagine that any other Web site could contain more vital information for a general or specialty ophthalmology practice. The Web site actually carries the title of the Centers for Medicare and Medicaid Services, or "CMS." As such, it provides information on the Medicaid program as well as the Medicare program.

The site, which was redesigned to be more user-friendly, appeared in its new form in December 2005. It boasts a search feature powered by Google that allows users to find specific information from within the vast amount of available data.

The site provides many benefits. In many situations, it allows for one-stop informational shopping. The search feature is indispensable in this regard. Further, the information that appears is official and can be relied upon as accurate from the standpoint of CMS.

Site components

There are eight top-level subjects. The five most relevant of these are Medicare, Medicaid, Regulation, Outreach, and Resources. Each of the top-level subjects is broken down, allowing the interested practitioner to hone into the area of interest quickly.

Information on coding guidelines, policies, billing information, legislation, the Health Insurance Portability and Accountability Act (HIPAA), and fraud and abuse can be found readily. One of the more useful components of the site is the Physician Fee Schedule Lookup, which provides fee schedule amounts and Relative Value Units for any particular CPT code.

Multiple educational resources are available on the site. The Medicare Learning Network is an important tool, providing information for residents and new physicians, coders and billers, and established providers. Topics addressed include the Advance Beneficiary Notice, screening services, appeals, and the remittance advice (Medicare Explanation of Benefits). Also available are the Internet-only Medicare Manuals, which provide a wealth of information across a broad range of topics.

One of the more useful manuals available is the Medicare Claims Processing Manual (publication 100-04). It is frequently helpful to know the rules the carrier must follow when processing a claim. There is no reason to guess about these rules because Medicare contractors (your state or region's Medicare carrier is one of these) abide by the protocols put forth in this manual.

Medicare forms can be downloaded from the site. Examples are the Advance Beneficiary Notice form, the Notice of Exclusions from Medicare Benefits, and the Disclosure of Ownership and Control Interest statement.

Physicians Resource Center

Most of the information you are likely to seek is available from the "Physicians Resource Center" in the Provider Center. Navigation is quite efficient from this launching point.

From the Physician Resource Center, links can be found to billing and payment information; coding, modifiers, and the National Correct Coding Initiative; and prescription drug coverage.

An example from clinical practice will drive home the advantages of familiarity with the Web site. Say you contemplate performing cataract surgery with IOL implantation in a patient with vitreous herniation through a miotic pupil. You anticipate that iris manipulation and subtotal anterior mechanical vitrectomy will be required. Assume that you practice in Virginia and that the Medicare contractor is Trailblazer Health Enterprises.

You should take several steps in anticipation of this operation. First, you will want to know if the procedure qualifies as complex cataract surgery (CPT 66982) rather than routine cataract surgery (CPT 66984). An easy way to check this is by referring to a local coverage determination (LCD) that has been issued for your locality.