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

Chapter 1 Overview of Billing

• 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

Chapter 2 Hard Copy Versus Electronic Claims Processing

• 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

Chapter 3 Billing Medicare

• 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

Chapter 4 Billing Medicaid

• 4.1 About Medicaid Billing
• 4.2 Medicaid Approval and Export Process
• 4.3 Medicaid Timely Filing

Chapter 5 Billing Private Insurance

• 5.1 Procedure for Billing Private Insurance
• 5.2 Private Insurance Timely Filing

Chapter 6 Third Party Liability Billing

• Third Party Liability Billing and Medicare Claims

Chapter 7 Billing Private Dental Insurance

• 7.1 About Dental Insurance
• 7.2 Reporting Dental Services
• 7.3 Dental Billing Guidelines
• 7.4 Dental Timely Filing

Chapter 8 Billing Pharmacy

• About Point-of-Sale Pharmacy Billing
• 8.2 Guidelines for Submitting a Claim Form Manually
• 8.3 Reasons for Pharmacy Denials

Chapter 9 Secondary Billing Process

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

Appendixes

1. IHS Reimbursement Methods
2. CMS 1450/UB-92 Form