U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Business Office Enhancement
 
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Revenue Operations Manual (ROM)


Part 4 - Billing

Click on any Chapter Title to download, view, or print individual chapters and appendices.

Chapter 1. Overview of Billing [PDF-123KB]

  • 1.1 About the Revenue Operations Manual
  • 1.2 About the Billing Process
  • 1.3 General Billing Policy Statement
  • 1.4 General Billing Guidelines
  • 1.5 Capturing all Reportable and Billable Services
  • 1.6 About the CMS-1450 / UB-92 Form
  • 1.7 Modifiers and their Role in Billing
  • 1.8 Place of Service
  • 1.9 "Incident To" Services
  • 1.10 Billing Form Review
  • 1.11 Utilization Review
  • 1.12 Roll-Over/Cross-Over for Secondary and Tertiary Billing
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Chapter 2. Hard Copy Versus Electronic Claims Processing [PDF-42KB]

  • 2.1 Hard-Copy Claims Processing
  • 2.2 Monitoring Approved Claims
  • 2.3 Electronic HIPAA compliant claims processing
  • 2.4 Electronic Data Interchange Alternatives
  • 2.5 Tips for Electronic Submission of Claims
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Chapter 3. Billing Medicare [PDF-174KB]

  • 3.1 About Medicare Billing
  • 3.2 Common Working File (CWF)
  • 3.3 Medicare Claim Change Condition Codes
  • 3.4 Provider/Supplier Types
  • 3.5 Procedure for Billing Medicare
  • 3.6 Inpatient Medicare Part B
  • 3.7 Ambulatory Surgery Center Billing - Medicare
  • 3.8 Medicare Secondary Payer (MSP)
  • 3.9 Medicare Secondary Payer (MSP) Claims Investigation
  • 3.10 Medicare Timely Filing
  • 3.11 Claims Resubmission Guidelines
  • 3.12 Reimbursement for Clinical Nurse Specialist or Nurse Practitioner
  • 3.13 Reimbursement for Physician Assistant
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Chapter 4. Billing Medicaid [PDF-30KB]

  • 4.1 About Medicaid Billing
  • 4.2 Medicaid Approval and Export Process
  • 4.3 Medicaid Timely Filing
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Chapter 5. Billing Private Insurance [PDF-68KB]

  • 5.1 Procedure for Billing Private Insurance
  • 5.2 Private Insurance Timely Filing
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Chapter 6. Third Party Liability Billing [PDF-25KB]

  • Third Party Liability Billing and Medicare Claims
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Chapter 7. Billing Private Dental Insurance [PDF-43KB]

  • 7.1 About Dental Insurance
  • 7.2 Reporting Dental Services
  • 7.3 Dental Billing Guidelines
  • 7.4 Dental Timely Filing
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Chapter 8. Billing Pharmacy [PDF-31KB]

  • About Point-of-Sale Pharmacy Billing
  • 8.2 Guidelines for Submitting a Claim Form Manually
  • 8.3 Reasons for Pharmacy Denials
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Chapter 9. Secondary Billing Process [PDF-29KB]

  • 9.1 Creating Secondary Claims
  • 9.2 Printing the Rollback Detail (ROD) Report
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Appendixes

  1. IHS Reimbursement Methods [PDF-36KB]
  2. CMS 1400/UB-92 Form [PDF-391KB]
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