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Medicare Payment and Regulations Resources

We understand the challenges of keeping current on how to appropriately bill and code for your Medicare patients. Below are a few resources to help you ensure that you are paid appropriately and are not in violation of any Medicare policies.

Medicare’s New Add-on Code G2211

Starting January 1, 2024, CMS implemented the new Medicare add-on code G2211 to better recognize and reimburse the resources necessary to provide patients with longitudinal, continuous care. G2211 will allow clinicians to account for services like chronic disease management tracking, review of consultative or diagnostic reports, and medication monitoring. CMS created this new code to capture these previously unrecognized elements of continuous, longitudinal care based on a clinician's relationship with a patient.

Office and outpatient E/M visits can serve as the continuing focal point for all needed health care services, making them comprehensive and often complex.Ìý For more information on the use of and reimbursement for G2211, members are encouraged to review ACP’s informational sheet and video supplement, and the Outpatient Services learning module in the Coding for Clinicians series. As part of ACP’s Coding for Clinicians subscription series, members should be on the lookout for a learning module on G2211 which will go into greater depth and cover additional aspects of billing and reimbursement.

As clinicians begin to use G2211, ACP continues to work with CMS and ask for additional guidance and clarification on the usage of this code to ensure clinicians are receiving reimbursement and the code is covered across Medicare and Medicare Advantage payors as appropriate.

Quality Payment Program (QPP)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) to transition physicians away from a volume-based system toward one that rewards value.

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Telehealth Guidance and Resources

Offering guidance on clinical use cases, technology, regulations and waivers, and billing and coding.

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Getting Started with Medicare

  • : Free tools from CMS that allow doctors and their staff to learn about a broad range of Medicare related issues.

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How to Comply with Medicare Regulations

Advance Care Planning

  • Advance Care Planning Tool Kit: This tool kit helps practices implement and bill for Advance Care Planning and end-of-life discussions. (ACP login required)

Chronic Care Management

  • Chronic Care Management (CCM) Tool Kit: This new tool kit provides what practices need to implement the new CCM codes, including background information for clinicians and staff, a step-by-step implementation guide, and a sample patient agreement. (ACP login required)
  • Resources from CMS:

Transition Care Management Codes

Preventive Care Visits

Home Health Face-to-Face Encounter Requirement

Care Plan Oversight Encounter Worksheet and Instructions

Quality Payment Program

Medicare Improper Payment Review

Advanced Beneficiary Notices (ABN)

Medicare Part D Resources