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How to Use Medicare and Medicaid Guide

The Medicare and Medicaid Guide on the Internet Research Network

All of the content that is available in print is also available on CD and on the CCH Internet Research Network® (IRN). Accessing the CCH Medicare and Medicaid Guide through the IRN provides you with so much more information. Among the added documents and features are:

Customers who use the Guide on the IRN have the ben- efit of CCH Smart Relate®, which provides links between all related explanations and primary source documents. For example, if you looked at a new Final rule via CCH Smart Relate, with a click of a link you will access a list of all related official text documents, laws, regulations, and CCH Explanations.

Durable Medical Equipment Manuals and Newsletters for each of the Jurisdictions A_D are included.

Finall , the Guide is supplemented via the DDUs daily as new official text documents are added. Using the “Daily Document Update” link online allows you to check each day what is new in the program. For your further convenience, you can sign up for our Tracker program. Using Tracker, we will send you an e-mail each day that a document that is of interest to you has been added to our database. e e-mail provides a summary of the document and a link to the full text.

IRN subscribers can add on all reported cases and rulings in full text of the archived official text information from1969 through 1996. Included in the Archive Rulings and other documents are all the special pamphlets issued to print subscribers.

In addition, with some IRN subscriptions, you have ac- cess to all the CMS Manuals, both the Paper Based and the Internet Only Manuals, as well as Archive CMS Manuals from 2000 forward.

IRN subscribers have the annual Master Medicare Guide with links to both the explanations and official text documents in the Guide.

Local Coverage Determinations are included in full text.

Internet Tools are available to speed research as well as locate documents.

DRG and APC tables are available in Excel or RTF format to allow for downloading and/or exporting to a user's desktop.

Quick Links allow the researcher to locate topics and/or sub-topics of interest. Subscribers select a Categor , then select the Topic and Sub-topic of interest. One or more links will display at the bottom of the page. Most links connect to topi- cal discussions written by CCH editors with links to relevant documents. Some links connect directly to source material on the selected topic.

Users of the Guide on the IRN also have the benefit of CCH Smart Relate®, which provides cross-references between all re- lated explanations and documents. For example, if you looked at a new Final rule via CCH Smart Relate, with a click of a link you will access a list of all related official text documents, laws, regulations, and CCH explanations.

Contents of the subject divisions are identical for the print and CD or internet subscribers; however, the arrangement is different for the electronic media.

Medicare explanatory divisions in the print are located under the menu item Explanations and Annotations for the CD and/ or internet subscribers.

CCH editors arrange all the explanatory material that appears in the first three print volumes by topic and subtopic. e Editors assign a separate paragraph (¶) number to each subtopic, and provide an explanation, based on the material collected, for each of these subtopics. e explanations are based on the law, regula- tions, and official materials issued by the federal government, and are presented in an understandable manner. e explanatory text contains citations to the sources used and are followed by annota- tions summarizing relevant documents, most of which have been reported in full text in previous Reports.

Explanations of Medicare Parts A, B, C, and D, including eligibility and coverage information, are found throughout Vol- umes 1 and 3 of the Gui e. e last subject division in Volume 1 covers the various prospective payment systems (PPS) that determine reimbursement for different Medicare providers.

  • e focus of Volume 2 of the Guide is on Medicare’s ret-

rospective cost-based system. ese divisions are organized around Part 1 of the Provider Reimbursement Manual (PRM). Each section of the PRM is in full text and treated as a separate subtopic. Most chapters of the PRM are preceded by the ap- plicable regulations, and each section is followed by a source note tracing the history of the section and by annotations giving the substance of rulings, court decisions, Provider Reimbursement Review Board decisions, etc., on the same subtopic. ere is a line in small type at the end of each of these annotations, identifying the source of the annotation and giving the paragraph number (¶) where the material was first reported in the Guide.

  • e next division is an overview of Part II of the Provider Re-

imbursement Manual, which consists of the Medicare provider cost reporting forms and the instructions for completing them.

  • e next three divisions relate to the forms used by provid-

ers for billing purposes. Instructions from CMS manuals for completing these forms are included in this division.

Medicaid explanatory divisions in the print are located under the menu item Explanations and Annotations for the CD and/ or Internet subscribers.

  • e Medicaid program is explained in Volumes 3 and 4. e

Medicaid finding lists are in Volume 1. Medicaid fraud and abuse information is in Volume 3, Medicaid laws are in Volume 4, Medicaid regulations are in Volume 5, and Medicaid current developments are in Volume 6.

  • e first four of these Medicaid divisions describe such

topics as eligibility, coverage groups, services covered, payment rules, and program structure. In Volume 4, the Medicaid State Plan division summarizes the variations in state Medicaid programs.

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