Medicare Benefit Policy Manual (CMS Pub. No. 100-02)
The Medicare Benefit Policy Manual contains 16 chapters that detail Medicare’s covered Part A and Part B benefits and services and CMS's coverage rules. The chapters focus on topics such as Inpatient Hospital Services Covered Under Part A, Home Health Services, and Ambulance Services. Chapter 15, Covered Medical and Other Health Services, describes most of the Part B benefits and services, including physician services, and Durable Medical Equipment (DME). Chapter 16 details the services that Medicare excludes from its coverage. It is important to keep in mind that the coverage rules in this manual apply to both the Original Medicare and Medicare Advantage (MA) programs. 

Medicare National Coverage Determinations Manual (CMS Pub. No, 100-03)
The Medicare National Coverage Determinations (NCD) Manual organizes more than 300 NCDs into medical specialty groups. For example, 6 NCDs are listed under Anesthesia and Pain Management and 30 are grouped under Cardiovascular System. The National Coverage Determinations are significant in that they are binding on Original Medicare’s payment contractors, Medicare Advantage (MA) plans, and on Administrative Law Judges (ALJs) in the Medicare appeals process. Regardless of arguments in favor of medical necessity, Medicare Administrative Contractors (MACs), MA plans, and ALJs cannot reverse a coverage denial that results from an NCD. In addition, waiver of liability protections do not apply to beneficiaries who face a claim denial based on an NCD. 

Medicare Claims Processing Manual (CMS Pub. No. 100-04)
The Medicare Claims Processing Manual contains 37 chapters with claims processing guidance for providers in the various health care settings. There are chapters, for example, that deal specifically with Hospice, Durable Medical Equipment, and Ambulance claims. This manual also has chapters that detail the appeal procedures that Medicare Administrative Contractors (formerly Fiscal Intermediaries and Carriers) must follow, as well as the procedures related to Advance Beneficiary Notices (ABNs) and the financial liability protections that may be available to beneficiaries and providers when Medicare denies payment on some claims. 

Medicare Managed Care Manual (CMS Pub. No. 100-16)
The Medicare Managed Care Manual contains 20 chapters that deal with the administration and operation of Medicare Advantage (MA) plans and Medicare Cost plans. While some of the chapters focus on contractual and payment issues that do not directly affect beneficiaries, others are especially relevant for them. Chapter 4, for example, addresses MA plan benefits and beneficiary protections. It contains rules dealing with access to care and covered benefits. Chapter 13 details the grievance and appeals procedures for Medicare Advantage plans, including the definitions of terms such as organizational determination. 

Medicare Prescription Drug Benefit Manual (CMS Pub. No. 100-18)
The Medicare Prescription Drug Benefit Manual compiles CMS's guidance documents for the Part D Prescription Drug Program. Its 13 chapters address such issues as formulary requirements and marketing guidelines. It is important to know that Chapter 3 deals with enrollment and disenrollment, Chapter 4 details beneficiary protections such as out-of-network access to drugs, and Chapter 13 describes the low-income subsidy program, including the Best Available Evidence (BAE) rules.