Home Health and Hospice New Provider Resource Center
New to Medicare?
Are you new to Medicare, or to billing Medicare claims to CGS? CGS is here to help, and we welcome you to the Medicare program. This page contains basic information and resources to get you started. Home health and hospice providers should become familiar with all of the resources listed on this page as well as the Centers for Medicare & Medicaid Services (CMS) web site (www.cms.gov).
CGS encourages all providers to use these resources to research issues and verify the answers to their Medicare questions prior to calling the Provider Contact Center for assistance. As a provider, you are held accountable for understanding information you receive from CMS and CGS. Please share this information with your staff as appropriate.
If you submitted your completed CMS 855-A enrollment application, and received a letter from CGS welcoming you as a Medicare certified provider, please proceed on with the steps detailed below. If not, please review the Provider Enrollment Packet web page for information on becoming a Medicare-certified provider.
To Get Started
Step 1: Enroll in the CGS ListServ Notification Service and CMS Listserv
These are the primary means used by CGS and CMS to communicate new or changing Medicare information with providers. Sign-up so that you are always "in the know" when it comes to Medicare.
Step 2: Become familiar with the CGS and CMS Web Sites
Take the Navigating the CGS Web site online course for a brief overview of our web site and how to navigate.
Please note the "Search" function on the web site. Use this to receive a listing of information posted to the CGS web site on various Medicare topics.
Familiarize yourself with important information found on the CMS web site.
- Official site for CMS, the federal agency that administers Medicare.
- Current updates and information regarding Medicare: http://www.cms.gov/
- Medicare Learning Network (MLN) Products
- Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers and Billers"
- MLN Guided Pathways to Medicare Resources – Basic Curriculum for Health Care Professionals, Suppliers, and Providers
- MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health Care Providers
- MLN Matters Articles
- Web-based Training Modules offered by CMS
- Become familiar with the information accessible from the "main pages."
The CGS web site also contains " Helpful Links " to Medicare information found on other Web sites, including the CMS web site.
Step 3: Enroll and Learn About Electronic Billing
Read the Electronic Enrollment Packet. This packet provides information about submitting your claims electronically to Medicare. You must bill your claims electronically, unless you meet the exception for a small provider.
Complete Electronic Data Interchange (EDI) Forms. You must submit the following forms to sign up to submit your claims electronically. The EDI forms must be completed online by typing your information directly into the application form. The forms and instructions can be accessed from the Electronic Enrollment Packet. Once completed, print the application, obtain an authorized signature, and fax it to the fax number indicated on the form.
- J15 EDI Application
- J15 EDI Online Inquiry
Step 4: Get Acquainted with Medicare
Below is a list of critical resources you will need for providing and billing Medicare-covered services. Consider bookmarking these web addresses for future reference.
- Provides information about upcoming webinars, teleconferences and workshops for providers. Updated frequently. Please check this page often.
- Types of Educational Events and Definitions:
- Webinars: participate through Internet connections (for visual) and telephone (for audio)
- Teleconference: participate through telephone
- Workshop: face-to-face, instructor led educational event – participants will need to travel to workshop site to participate.
- Register for CGS-sponsored events and details for how to register for partnering events.
- Monthly newsletter published by CGS
- Posted on this web site ( http://www.cgsmedicare.com/hhh/index.html ) under "News & Publications"
- Provides updates, clarifications and/or corrections to Medicare guidelines, coverage and reimbursement
- Medicare Benefit Policy Manual (CMS Pub. 100-02) – Chapter 7 provides home health information about the Prospective Payment System, qualification for covered home health services, physician certification, and plan of care information. Chapter 9 provides hospice general, certification, and election requirements, and hospice benefit coverage information.
- Medicare Claims Processing Manual (CMS Pub. 100-04) – Chapter 10 provides general guidelines for processing home health claims, information about completing the Request for Anticipated Payments (RAPs) and final claims, and consolidated billing information. Chapter 11 provides information about Notices of Election (NOEs), billing and payment of general hospice services, and hospice services provided by physicians.
- Medicare Program Integrity Manual (CMS Pub. 100-08) – Chapter 1 contains Medical Review requirements and information about the benefit integrity program.
Interactive Voice Response (IVR) System
Automated self-service tool that assists home health and hospice providers with answers to various Medicare questions, including:
- Beneficiary eligibility information (Medicare Part A or B enrollment dates: Medicare Secondary Payer (MSP) record effective/termination dates; Medicare Advantage plan enrollment dates; home health episode dates; hospice benefit period dates, etc.)
- Claim status information (beginning and ending dates of claim; total charges submitted on claim; status of claim; etc.)
- Check Information (the date and amount of the most recent check or the amount for a specific check)
- General information (most requested telephone numbers and addresses, hours of operation, remittance advice code definitions; and appeal rights information.
Refer to the Interactive Voice Response (IVR) System User Guide for additional information.
Provider Reimbursement Manual – Part 1 (CMS Pub. 15-1)
Provider Reimbursement Manual – Part 2 (CMS Pub. 15-2)
These are available online in the paper-based manual format. These are the only paper-based manuals that providers should use. All other information is found in the CMS Internet-Only Manuals.
- Instructions on calculating Medicare payments.
- Instructions on submitting an annual Medicare cost report (MCR) to the fiscal intermediary.
Access to provider-specific materials:
- Contains both detailed and quick resource materials
- Home Health Claims Filing and Special Claims Filing Situations
- Home Health Quick Resource Tools
- Hospice Claims Filing and Special Claims Filing Situations
- Hospice Quick Resource Tools
- Newly Certified Home Health Provider or Provider Number Change
Local Coverage Determinations (LCDs) / Coverage
- Active LCDs are policies developed by CGS. They are available from the Medicare Coverage Database and provide guidance concerning Medicare coverage and payment when no national policy exists.
- Home Health Coverage Guidelines
- Hospice Coverage Guidelines
- Gain an understanding of the CERT program established by CMS to ensure contractors are paying claims appropriately and how this impacts you as a Medicare provider.
Step 5: Biller/Clinician Checklists
- If you are a biller or clinician in your organization, please complete the appropriate checklist to assist you in your understanding of Medicare.
- Biller Checklist
- Clinician Checklist