Health Care Reimbursement
Important Regulatory Agencies
Center for Medicare and Medicaid Services (CMS). Administers the Medicare program, coordinates with state Medicaid programs, develops regulations for all aspects of Medicare and Medicaid, conducts and reports on research into the cost effectiveness of treatment strategies, determines coverage, sets prices, etc.
Food and Drug Administration (FDA). Issues approvals, recommendations, research, and other information about which devices, drugs, and foods are safe and effective. Its rulings and advisory statements typically inform insurance coverage decisions. NOTE ESPECIALLY THE APPROVALS AND CLEARANCES TAB.
United States Patent and Trademark Office (USPTO). Publicly accessible database of all patent applications and decisions. The Johns Hopkins community also has access to two proprietary patent searching databases:
Classification and Coding Systems
- International Classification of Diseases (ICD) Diagnosis and Procedure Codes
- ICD-9 Diagnosis Code Lookup (Keyword)
- ICD-9 Diagnosis and Procedure Codes List
- ICD-10 Diagnosis Code Lists (List of downloadable files on the Medicare website)
- ICD-10 Diagnosis Code Lookup (Keyword)
- ICD-10 Procedure Code Lists (List of downloadable files on the Medicare website)
- Healthcare Common Procedure Coding System (HCPCS) Overview
- Level I HCPCS Procedure Codes (Same as CPT Codes--Get from Web search or AMA Website)
- Level II HCPCS Procedure Codes (Medical equipment and supplies coding system for payment)
- List of Codes (from Medicare/CMS website)
- List of Codes (from HCPCSData.com, a free proprietary website)
HCPCS codes caveat: These codes are generally identical to CPT codes; however, the Medicare-generated HCPCS coding system only includes codes that are reimbursed by Medicare. In other words, they are not a complete substitute for CPT codes, which are a proprietary product of the American Medical Association.
- Medicare Severity-Diagnosis Related Groups (MS-DRGs) Explained
- Medical Diagnosis Categories (MDCs)
- MS-DRGs List (Drill down in MDC list)
- Ambulatory Payment Classifications (APCs)--Addendum B translates HCPCS procedure codes to APCs & Addendum A shows payment amounts for each APC.