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 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

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.

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.
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 website.
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.
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.
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.

myCGS Portal

Appeals/Redeterminations

Electronic Data Interchange (EDI)

Education & Resources

FAQs

Financial

Forms

LCDs / Medical Policies

Medical Review

News & Publications

Overpayments & Refunds

Provider Enrollment

Self-Service Options

Print | Bookmark | Email | Font Size: + | –

Home » Home Health & Hospice » Education » Home Health and Hospice New Provider Resource Center

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) website. 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 and CMS Electronic Mailing List (Listserv)

Access the CGS Email Registration, which is the primary means used by CGS to communicate new or changing Medicare information with providers. CGS also communicates information via Facebook and LinkedIn. In addition, sign up for the weekly MLN Connects® for all Medicare program news, including MLN Matters Article and MLN product updates.

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 site.

Official site for CMS, the federal agency that administers Medicare
Current updates and information regarding Medicare
Medicare Learning Network (MLN)
- MLN Matters Articles
  - The Affordable Care Act (ACA) included new statutory authority for a provisional period of enhanced oversight for new providers and suppliers to the Medicare program. New HHAs that are placed on a provisional period of enhanced oversight will be subject to enhanced oversight that includes a suppression of Request for Anticipated Payment (RAP) payments for 30 days to 1 year. Refer to SE19005 for additional information.
MLN Web-Based Training 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.

Top

Step 3: Enroll and Learn About Electronic Billing and myCGS

Read the Internet EDI 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 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.

Log In and Register for myCGS! 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.

Top

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 Calendar of Events

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

Medicare Benefit Policy Manual (CMS Pub. 100-02) – Chapter 7 provides home health information about the 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 hospice 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) / 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 and redetermination 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.

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 Medicare Beneficiary Identifier (MBI) and Name to Number Converter Web page to assist with entering MBI and the beneficiary name into the IVR and CTI.

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.

Educational Materials and Resources

Access to provider-specific materials:

Contains both detailed and quick resource materials
- Home Health Claims Filing and Special Claims Filing Situations
- Home Health Patient-Driven Groupings Model (PDGM) – Effective for claims with "From" dates on or after January 1, 2020.
- 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

Self-Service Options

The Self-Service Options web page includes a variety of tools designed to assist providers who submit claims to CGS.

Local Coverage Determinations (LCDs) / Coverage

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

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.

Top

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.

Top

Step 6: Contact Us / Education Request

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 (PCC). As a provider, you are held accountable for understanding information you receive from CMS and CGS. If you need assistance, refer to the Customer Service Contact Information web page for additional resources.

As a new Medicare provider, if you wish to have individual training, please send your request to J15_HHH_Education@cgsadmin.com, and provide your contact information, Medicare provider number, and what type of education needed.

Top

Updated: 11.29.21