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Ex Libris
Medicare & Medicaid Paper-Based Manuals (Electronic Copies of Paper Manuals)

 

 

These files recreate a relatively complete version of the individual CMS program manuals that are in hardcopy paper format. These manuals contain operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives from the Medicare and Medicaid programs. Medicare and Medicaid make every effort ensure the accuracy of these documents in electronic form. Because these forms refer you to another site for information, Vidyya does not claim responsibility for the content herein.

Two other sites may have useful information. Program Transmittals and Program Memoranda may include documents that reflect current policies and procedures not yet incorporated into these manuals.

Publication #
Title
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Pub 6 The Coverage Issues Manual contains national coverage decisions and sets forth whether specific medical items, services, treatment procedures, or technologies are paid for under the Medicare program. View &
Print
Download (337 kb)
(4 kb)
Pub 7 The State Operations Manual provides operating policies and procedures for state survey agencies charged with ascertaining whether health and safety standards are met. It provides State agencies with instructions for participation in the Medicare/Medicaid programs. It includes procedures for surveying providers and suppliers and for evaluating their performance in rendering a safe and acceptable quality of care. Revised HTML version is under development Download &
Print
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(6 kb)

(5 kb)
Pub 9 The Outpatient Physical Therapy/CORF Manual makes available to the provider of outpatient physical therapy, information, and procedural material applicable to the delivery of physical therapy and rehabilitative services to Medicare beneficiaries. It includes claims processing instructions, billing procedures, coverage requirements, and related matters. View &
Print
Download (495 kb)  
Pub 10 The Hospital Manual contains information that is issued to hospitals participating in the Medicare program. It contains the policies and procedures applicable to the delivery of hospital services, claims processing instructions, billing procedures, coverage requirements, and related Medicare matters. View &
Print
Download (1,538 kb)  
Pub 11 The Home Health Agency Manual contains the policies and procedures applicable to the delivery of home health services to Medicare beneficiaries, billing procedures, coverage requirements, and related matters governing the agencies' performance under the program. View &
Print
Download (1,299 kb)  
Pub 12 The Skilled Nursing Facility Manual delineates the providers' responsibilities for claims submitted on behalf of Medicare beneficiaries. It includes the claims information necessary and the requirements for services covered under the program. View &
Print
Download (1,352 kb)  
Pub 13 The Intermediary Manual-Part 1-Fiscal Administration provides operating policies and procedures for fiscal intermediaries charged with paying providers under Medicare. In general, it states CMS policies concerning the intermediary's preparation of budgets letting (sub) contracts and its accountability to Medicare. This manual provides the procedures to follow in order to secure Medicare funds to pay to participating providers for services covered under the program. For more information on Part 1, view the Financial Management Manual Download (5 kb)  
   Part 2-Audits, Reimbursement, Program Administration includes an integral part of the contract between CMS and fiscal intermediaries. In general, it states CMS policies concerning intermediaries' reimbursable costs. It also provides intermediaries with instructions for claiming reimbursement and the time frames for processing requests. It delimits the intermediary's responsibility in making payment to providers of services covered under Medicare Part A. For more information on Part 2, view the Financial Management Manual Download (5 kb)  
   Part 3-Claims Process contains instructions and procedures for processing claims, including coverage limitations and coverage requirements. The beneficiary appeals process is included. View &
Print
Download (5 kb)  
   Part 4-Audit Procedures deals with audits formerly in HCFA Pub 2, including all fiscal intermediary instructions on how to conduct audits of participating providers. For more information on Part 4, view the Financial Management Manual Download (5 kb)  
Pub 14 The Carriers Manual-Part 1-Fiscal Administration (Publication 14-1) provides operating policies and procedures for contractors charged with administering the Medicare program. It has instructions on reimbursement of contractor administrative costs; budget preparation and execution; letter of credit method of advancing funds; and carrier accountability. For more information on Part 1,view the Financial Management Manual Download (5 kb)  
  Part 2-Program Administration (Publication 14-2) contains administrative guidelines such as systems security procedures, contractor performance evaluation, legal processes, and records management. For more information on Part 2, view the Financial Management Manual Download (5 kb)  
  Part 3-Claims Process (Publication 14-3) contains informational and procedural material the carrier needs for efficient processing and payment of claims. This includes instructions dealing with coverage of services, bill review, reasonable charges, and other pertinent claims procedures. View &
Print
Download (5 kb)  
  Part 4-Professional Relations (Publication 14-4) contains the contacts that carriers must develop with physicians, laboratories, etc., from whom they can reasonably expect claims. This includes the carrier's criteria for accepting claims. It also explains how unique physician identification numbers will be assigned and the data that physicians provide for this purpose. For more information on Part 4, view the Financial Management Manual Download (5 kb)  
Pub 15 The Provider Reimbursement Manual (PRM) includes instructions on calculating Medicare payments to hospitals and skilled nursing facilities that are reimbursed under the prospective payment system, as well as other providers that are reimbursed on a reasonable cost basis.      
  Provider Reimbursement Manual (PRM)-Part I   Part I
Download

(7 kb)
 
  Provider Reimbursement Manual (PRM)-Part II   Part II
Download

(8 kb)
 
  PRRB Appeals Information      
Administrator Decision Review
  The Medicare Geographic Classification Review Board Information      
Pub 19 The Peer Review Organization Manual provides guidance to PROs in implementing review functions, e.g., determining whether medical services provided (or proposed) are reasonable and necessary, are provided in the proper setting, and meet professionally recognized standards of health care. View &
Print
Download (715 kb)  
Pub 21 The Hospice Manual provides, in ready reference format, informational and procedural material hospices need for prompt and accurate filing of claims for services furnished under the provisions of the health Insurance for the Aged Act (Medicare). It also contains information the hospice may need to answer questions patients often ask about the program, and should help to assure that the law is applied nationally without regard to where covered services are furnished. View &
Print
Download (258 kb)  
Pub 23 Regional Office Manual Available to CMS staff through TIMS  
Pub 27 The Medicare Rural Health Clinic and Federally Qualified Health Center Manual provides RHCs with informational and procedural material needed for prompt and accurate filing of claims for services furnished under the provisions of the Health Insurance for the Aged Act (Medicare). View &
Print
Download (329 kb)  
Pub 29 The Medicare Renal Dialysis Facility Manual makes available to the non-hospital renal disease facility provider informational and procedural material needed for prompt and accurate filing of claims for services furnished under Medicare's provisions. It also contains information the provider may need to answer questions patients often ask about the program. View &
Print
Download (284 kb)  
Pub 45 State Medicaid Manual View &
Print
Download(5 kb)
(7 kb)
Pub 81 The ESRD Network Organization Manual provides technical instructions and/or changes in procedures in an understandable format which can be easily modified.   Download (673 kb)  

* This option is recommended if you require the printed pages to look as they do in the published manuals.

See the section on how to purchase manuals for additional information on securing your own copy.

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Note: Some of the files on this page are available only in Adobe Acrobat - Portable Document Format (PDF). To view PDF files, you must have the Adobe Acrobat Reader (minimum version 4, version 5 suggested). You can check here to see if you have the Acrobat Reader installed on your computer. If you do not already have the Acrobat Reader installed, please go to Adobe's Acrobat download page now.
SPECIAL NOTE: As you browse through the instructions in these program manuals, you may find instances where the Medicare address is incorrect. Manuals are periodically revised to correct these out-of-date addresses as they appear. The current address is:

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244



 
 



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