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Spotlight 

Cardiac and pulmonary rehabilitation programs
Medicare pays for cardiac rehabilitation (CR), intensive cardiac rehabilitation (ICR), and pulmonary rehabilitation (PR) programs if specific criteria are met. This criterion includes coverage provisions for CR, ICR, and PR items and services, physician standards, required components, and limitations to the sessions that may be covered.

• View CMS Newsroom Center  (Spotlights, news, media releases, outreach, mailing lists, etc.)
• CMS Quarterly Provider Updates (QPU) 

Medical documentation 

Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy.  Find information, tips, and resources regarding medical documentation.

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• Automatic External Defibrillators: Inadequate medical record documentation 
  Automatic External Defibrillator (AED) providers often submit claims lacking sufficient medical record documentation. Physicians and non-physician practitioners must follow Medicare requirements.
• Medicare Billing for Cardiac Device Credits fact sheet (ICN 909368)
  CMS developed this fact sheet to ensure hospitals properly report manufacturer credits for cardiac devices and avoid overpayment recoveries.
• Devices and clinical trials
• Coverage with Evidence Development (CED)
• Medicare Approved Facilities/Trials/Registries

LCD/NCD 

LCDs
Search for cardiology-related LCDs using these available tools:

• LCD interactive index tool
• View First Coast’s active / proposed LCDs on CMS’ Medicare coverage database (MCD)

NCDs
Search for cardiology-related NCDs using these available tools:

• Search CMS’ MCD
• CMS’ MCD - NCD alphabetical index
• NCD 20.4 Implantable Cardiac Defibrillators (ICDs) (SE20006)
  This article updates providers on Medicare coverage rules and policies for NCD 20.4 – Implantable Cardiac Defibrillators (ICDs), outlining coding requirements (including heart failure codes).
• Claims Processing Instructions for NCD 20.4 Implantable Cardiac Defibrillators (ICDs)  (MLN MM12104)
• Transcatheter Aortic Valve Replacement (TAVR) Hospital Program Volume Requirements
  Before a TAVR procedure is eligible for Medicare coverage individual hospitals must meet volume requirements specified in the TAVR NCD. Hospitals not meeting these volume requirements are not eligible for waivers or exceptions. You can review registry approvals and process on this page.
• NCD 20.33 -- Transcatheter edge-to-edge repair (TEER) for mitral valve regurgitation (TMVR)
• Here you can find additional CED information on TMVR, including information on registry approvals and clinical studies.

Audit and compliance 

• CERT resources
• Recovery Auditor (RA) resources
• Incident-to tool -- identify the appropriate application of incident-to requirements
• Medicare Provider Compliance Tips
• Complying with Documentation Requirements for Laboratory Services (ICN 909221)
• Provider Compliance Tips for Immunosuppressive Drugs (ICN 909466)
• Provider Compliance Tips for Laboratory Tests -- Blood Counts (ICN909481)
• Provider Compliance Tips for Ventilators

Cardiology services education 

Utilize educational information from First Coast and CMS on cardiology services.

• View First Coast upcoming events
• Visit the On-Demand Learning – access First Coast’s webcast recordings, web-based training, videos and tutorials.

CMS educational opportunities

• Search for CMS upcoming events
• CMS open door forums
• CMS Clinical Concepts Series: Cardiology
   

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CMS Internet-only manual (IOM)

The CMS IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives.

The following CMS manual contains information specific to cardiology services providers:

• Medicare National Coverage Determinations Manual, Pub. 100-03, Chapter 1, Part 1
  Chapter 1 of this manual offers information on various coverage decisions related to the cardiovascular system.
• Medicare Claims Processing Manual, Pub. 100-04, Chapter 12
  Chapter 12 of this manual offers correct coding information related to several cardiovascular procedures.

Resources

• Cardiac and pulmonary rehabilitation programs
  Visit the Physician Center on the CMS website.
  View additional resources identified specifically for cardiology services.
• CMS MCD
• Professional associations
• General resources

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