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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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(HIPAA) Medicare Part D Revenue Operations Manual (ROM) Third Party Internal Controls Patient Registration Third Party Billing National Business Office Coordinator’s Meeting Minutes Accounts Receivable Management Tools Unified Financial Management System (UFMS) Business Office Solutions Training ListServ Questions or Comments. Please contact the Site Manager

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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