Medicare Claims Processing Manual
CMS requirements for submitting, processing, pricing, and paying Medicare claims.
- General billing requirements
- Hospital and professional claims
- Payment-specific chapters
Compliance Resources
Revenue Integrity
Official references supporting accurate billing, medical necessity, payment integrity, and defensible reimbursement.
Reference standard: Confirm the current effective date and applicability of each source before relying on it for an audit finding, coding decision, provider education, or compliance determination.
Medicare NCCI
Correct-coding edits and policy guidance supporting accurate claim reporting.
- PTP edits
- MUEs
- Add-on code edits
Medicare Coverage Database
Coverage and medical-necessity requirements used in claim review and denial prevention.
- NCDs
- LCDs
- Billing articles
CMS Payment Systems
CMS information on Medicare fee schedules and prospective payment systems.
- Fee schedules
- Prospective payment systems
- Payment policy
MLN Publications
Provider education related to billing, reimbursement, documentation, and claims compliance.
- Fact sheets
- Booklets
- Compliance education