Social Security Act, Title XVIII: Primary legislation that established and governs the Medicare program, defining basic structure, benefits, and eligibility requirements
Medicare Modernization Act of 2003: Legislation that made significant changes to Medicare, including the addition of prescription drug coverage (Part D)
Affordable Care Act Medicare Provisions: Legislative provisions that modified Medicare benefits, payment systems, and introduced new quality measures and reporting requirements
HIPAA: Health Insurance Portability and Accountability Act that establishes standards for patient privacy, security of health data, and healthcare transactions
CMS Form 1500 Requirements: Specific requirements for the standard Medicare claim form, including proper completion and submission guidelines
NUCC Guidelines: National Uniform Claim Committee guidelines that standardize the gathering and exchange of healthcare claim information
Medicare Claims Processing Manual: Comprehensive guide providing instructions for processing Medicare claims and implementing Medicare policies
False Claims Act: Federal law that imposes liability on persons/companies who defraud governmental programs, including Medicare claims
Anti-Kickback Statute: Criminal law that prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce referrals for Medicare services
Stark Law: Physician self-referral law that prohibits physicians from referring Medicare patients to entities with which they have a financial relationship
Medicare Secondary Payer Rules: Rules determining when Medicare pays secondary to other insurance coverage, affecting claim submission requirements
HIPAA Privacy Rule: Federal regulations establishing national standards for the protection of individuals' medical records and personal health information
HIPAA Security Rule: Federal regulations establishing national standards for securing electronic protected health information
HITECH Act: Health Information Technology for Economic and Clinical Health Act that strengthens privacy and security protections for health information
Medical Necessity Documentation Rules: Requirements for documenting and proving that services provided were medically necessary for Medicare coverage
ICD-10 Coding Requirements: Standards for using International Classification of Diseases (ICD-10) codes in Medicare claims to report diagnoses
CPT/HCPCS Coding Guidelines: Guidelines for using Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes in Medicare claims
Local Coverage Determinations: Policies developed by Medicare Administrative Contractors determining coverage for specific procedures in their jurisdictions
National Coverage Determinations: CMS-developed policies determining coverage for specific procedures that apply nationwide
