1. Eligibility and Enrollment ✔ Verify the patient’s Medicare Part A, B, C, or D coverage✔ Confirm the provider is enrolled and approved by Medicare✔

1. Proper Documentation Practices ✔ Maintain detailed notes for every service billed✔ Match diagnosis codes with medical necessity✔ Record patient consent and service time accurately

1. Timely Filing Requirements ✔ Submit Medicare claims within 12 months of the service date✔ Check payer-specific deadlines for Medicaid or MACs✔ Recheck claims before

1. Access Control Measures ✔ Implement role-based access to systems and data✔ Use two-factor authentication (2FA) for all users✔ Restrict access to sensitive PHI based

1. Documentation Review ✔ Verify patient charts match billed services✔ Check for missing or incorrect CPT/ICD codes✔ Confirm signature and date requirements are met 2.

Key Provisions Provider Requirements✔ Must provide clear written notice of network status✔ Required to submit timely billing information to insurers✔ Must participate in independent dispute

What It Is A federal law that penalizes fraud against government healthcare programs (Medicare, Medicaid, TRICARE). How It Applies to Medical Billing ✔ Upcoding (billing for a more expensive

1. Protected Health Information (PHI) Safeguards ✔ Electronic Security: Encrypt billing software and emails containing PHI✔ Paper Records: Secure locked storage for physical documents✔ Access Controls: Limit staff