Mining Medicare's Manuals: Defining Key Terms

Here are definitions for some common terms that may come up when you're using CMS's Medicare manuals.

• Guidance: refers to the authority language found in CMS's manuals. CMS writes its manuals to guide payment contractors, providers, Medicare Advantage plan sponsors, Quality Improvement Organizations, and others in their day-to-day operations and dealings with CMS and Medicare beneficiaries.

CMS also uses the word guidance when referring to a specific chapter within a manual. For example, CMS refers to Chapter 2 of the Medicare Managed Care Manual as MA Enrollment and Disenrollment Guidance. You may find that CMS uses the word guidance in different ways, but in all cases the term refers to authority language that CMS incorporates into its manuals.

• Internet Only-Manuals (IOMs): The Internet-Only Manuals (IOMs) are CMS's on-line, day-to-day operating instructions, policies, and procedures. They are based on statutes, regulations, guidance documents, transmittals, models, and directives. CMS staff, providers, contractors, Medicare Advantage organizations, and state survey agencies use them as the written authority to administer CMS programs. The manuals are binding on CMS's payment contractors, QIOs, and Medicare Advantage (MA) Plans as they make coverage decisions.