CMS Pub. 100-06, ch. 1, § 100.3

A1-1213.3, B1-4213.3

The inquiries function includes the costs and workload(s) associated with inquiries

including Medicare customer service or billing/claims inquiries from beneficiaries or

providers by telephone, correspondence, walk-in or on-line inquiry. The costs of inquiries

received in the medical review (MR), Medicare Secondary Payer (MSP), and Benefit

Integrity (BI) departments should be charged to those activities. The carrier shall charge

the cost of beneficiary inquiries to obtain participating physician/supplier information to

participating physicians. However, it shall charge the costs of toll-free lines and

equipment to receive phone or electronic inquiries relating to the participating physician

activity and the costs of general inquiries from physicians to Inquiries.

100.4 - PM - Provider Education and Training (PET) Function

(Summary Level Code 14000) - (Rev. 1, 08-30-02)

A1-1213.4, B1-4213.4

The PM - PET function includes the costs for education and training directed at

providers, groups of providers, and in some cases, individual providers depending on the

scope of the problems or need for education. Costs of PET are allocated to both PM and

to MIP. Refer to §100.11 for MIP PET discussion.

100.5 - Provider Reimbursement Function (Summary Level Code

16000) - (Rev. 1, 08-30-02)

A1-1213.5

See §340.3. The Provider Reimbursement function (intermediaries) includes costs and

workload(s) for establishing and maintaining providers' accounting systems, submitting

cost reports for quality assurance and provider audits, maintaining records and files for

hospital-based physicians, and performing hospital cost reporting activities.