LICENSES AND NOTICES

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


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Transfer Dispute Between HHAs

Medicare Claims Processing Manual (CMS Pub. 100-04, Ch.10, §§10.1.13, 20.1.1, 20.1.2, 20.1.3, 30.1, 30.3External PDF)

In the rare circumstance of a dispute between HHAs, if the receiving HHA can provide documentation of its notice of patient rights on Medicare payment liability provided to the patient upon transfer and the contact of the initial HHA on the transfer date, then the initial HHA will be ineligible for a full episode payment, but will receive a Partial Episode Payment (PEP). If the receiving HHA cannot provide the appropriate documentation, the receiving HHA's RAP and/or final claim may be cancelled and full episode payment will be provided to the initial HHA.

HHAs should be aware that a transfer dispute does not exist if a beneficiary was discharged from "Agency A" during a 60-day episode or a 30-day period of care under the Patient-Driven Groupings Model (PDGM), and is subsequently re-admitted to "Agency B" when there are no overlapping dates of service between the date of discharge, and second admission date. A discharge from home health care would be evidenced by a patient status code other than "30" on ELGH page 03.

In addition, if a beneficiary was receiving home health services from another HHA within 60/30 days days of the second HHA's episode start date, CGS will review the patient status code submitted on the first HHA's episode when there is a dispute as to which HHA is the primary agency. If the patient status code indicates that the beneficiary was still a patient of the first HHA, the second HHA will need to produce documentation indicating the beneficiary transferred to their HHA in order for their episode to stand.

The Centers for Medicare & Medicaid Services (CMS) guidelines require that in the event a transfer dispute occurs, HHAs must first attempt to resolve the transfer dispute among themselves. Refer to the Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §10.8.)External PDFfor additional information.

The initial HHA must make at least three contacts with the receiving HHA. For each contact, the documentation should include the date and time of contact and name of the person contacted. If HHAs are not successful in resolving the transfer dispute, they may request assistance from their Medicare Administrative Contractor (MAC). To report a dispute of transfer, the initial HHA should submit the Notification of Disputed Home Health Agency (HHA) Transfer FormPDFif they bill their home health services to CGS. We would encourage you to print this form from our website each time it is needed to ensure you are using the most current form. Prior to submitting this form to CGS, HHAs should review the important reminders below:

  • Ensure the information on the completed form is legible. Forms that are illegible will be returned to you.
  • Return completed forms via U.S. Mail. Faxed forms will not be accepted due to the protected health information (PHI) required on the form. Faxes with PHI are in direct violation of the Centers for Medicare & Medicaid Services (CMS) policy.
  • The form must clearly document the HHA's attempt to resolve the dispute with the other HHA or it will not be accepted.
  • All admission documentation must be submitted with the transfer dispute form. If this documentation is not included, the case will be closed, and you will be contacted by telephone advising you to submit a new form with the required admission paperwork. CGS will not initiate an investigation into the transfer dispute unless both the needed documentation and "Notification of Disputed Home Health Agency (HHA) Transfer" form are received.

Upon initiating a transfer dispute investigation, CGS will request documentation from the receiving agency. A screenprint of ELGH Page 03 dated at the time the receiving agency admitted the beneficiary, and a signed and dated patient consent form are among the most crucial pieces of documentation used by CGS when determining whether the transfer will stand.

HHAs should be aware that resolving transfer disputes can be a lengthy process, especially when the other HHA has a MAC other than CGS.

Note: The "Notification of Disputed Home Health Agency (HHA) Transfer" should not be used when the HHA's services overlap services provided by another Medicare provider type (e.g. hospice, skilled nursing facility (SNF), inpatient hospital, outpatient hospital, etc.). CGS is not able to assist HHAs with these types of overlapping issues. HHAs will need to work out the overlapping issue with the other provider.

Updated: 12.18.19

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