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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) websiteExternal Website.

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 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

Sign up for the CGS ListServ Notification Service, which is the primary means used by CGS to communicate new or changing Medicare information with providers. CGS also communicates information via Facebook and Twitter. In addition, sign up for the following CMS Electronic Mailing lists to receive news from CMS, as well as CMS educational products and MLN Matters® articles with the latest changes to the Medicare program. Subscribe now and you will always be "in the know" when it comes to Medicare.

Step 2: Become familiar with the CGS and CMS Websites

Access the Home Health & Hospice CGS website for a variety of educational, billing, and coverage information. Take the Home Health & Hospice website video tour for a brief overview of our website and how to navigate.

Please note the "Search" function on the web site. Use this to receive a listing of CGS web pages or documents containing the word(s) entered in your search.

Familiarize yourself with important information found on the CMS Web siteExternal Website.

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 and myCGS

Read the Electronic Enrollment PacketPDF. 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 the Electronic Data Interchange (EDI) forms, which can be accessed from the Electronic Enrollment Packet. The EDI forms must be completed online by typing your information directly into the application form. Once completed, print the application, obtain an authorized signature and fax it to the fax number indicated on the form.

The CGS Web Portal, myCGS is a web-based application developed specifically to serve the needs of health care providers and their staff. The myCGS application provides a variety of functions from checking beneficiary eligibility, viewing and print Remittance Advices, to submitting Redeterminations and medical documentation. Access to myCGS is available 24/7, and is free of charge for all CGS providers. The myCGS User Manual provides detailed information about accessing and obtaining information from the myCGS web portal.

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.

Home Health & Hospice Education

  • 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.

Home Health & Hospice (HH+H) Medicare Bulletin

  • Monthly newsletter published by CGS
  • Accessed from the "News & Publications" left side menu link.
  • Provides updates, clarifications and/or corrections to Medicare guidelines, coverage and reimbursement

CMS Internet-Only Manual System

Interactive Voice Response (IVR) / Computer Telephone Integration (CTI) Systems

  • The IVR is an automated self-service tool that assists home health and hospice providers with answers to various Medicare questions without the assistance of a Customer Service Representative, 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 GuidePDFfor additional information.

  • The CTI is an automated self-service tool that authenticates beneficiary/provider information that is required before a Customer Service Representative can assist you with beneficiary/providers specific questions. Instead of verbally providing this information, the CTI captures what you enter and authenticates the information and displays it to the CSR.
  • Refer to the IVR and CTI Converter Tools Web page to assist with entering MBI and the beneficiary name into the IVR and CTI.

Provider Reimbursement Manual – Part 1External Website (CMS Pub. 15-1)

Provider Reimbursement Manual – Part 2External Website (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 ManualsExternal Website.

  • Instructions on calculating Medicare payments.
  • Instructions on submitting an annual Medicare cost report (MCR) to the fiscal intermediary.

Educational Materials and Resources

Access to provider-specific materials:

Local Coverage Determinations (LCDs) / Coverage

Comprehensive Error Rate Testing (CERT) Program

  • 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

Updated: 04.23.19

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