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

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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.
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March 7, 2019

Process Improvements Based On Your 2018 MSI Survey Feedback!

Your voice was heard and appreciated. We made improvements within the past year in response to your comments in the 2018 Medicare Administrator Contractor (MAC) Satisfaction Indicator (MSI) Survey feedback results. Based on your feedback, CGS enhanced the following.

Appeals:

Are you often confused if you should request an appeal? We now have the tool that can help. The Appeals Decision Tree was developed to assist you in determining if a reopening or a redetermination is appropriate. The decision tree walks you through a series of questions to help you determine your next step.
If you need assistance with knowing what to submit with an appeal, check out the new Icon "What Should I Submit With my Appeal" available now on the Appeals/Redeterminations Web page. This icon links to a Redetermination checklist that provides assistance in determining what type of documentation to submit with your Redetermination request.

Audit & Reimbursement:

Have questions for the Part A Audit & Reimbursement staff? You can find email addresses and telephone numbers for A&R staff by selecting the Contact Information, icon on the Audit and Reimbursement Web page.

Claims

If you need assistance with submitting Medicare Secondary Payer (MSP) claims, you can now access new Medicare Secondary Payer (MSP) resources for Part A providers. These resources are available by selecting "Claims", or the "Browse by Topic" links on the left side navigation menu on the Part A website. The new resources include:
Are you always searching for the most recent Medicare deductible/coinsurance information? Look no further! CGS has developed a quick and easy Medicare Deductible / Coinsurance Look-Up tool that provides access to deductible and coinsurance amounts for the year selected.
We have worked hard to ensure that claims issues are updated frequently and timely on the Claims Processing Issue Log. We have even updated the layout of the issue log to ensure the most pertinent information is displayed!
Check out the Reason Code Search and Resolution self service option! This tool was designed for Part A providers to allow quick and easy access to specific reason codes and information on how to resolve the edit. The feature is searchable by reason code or keyword and is located on the Claims page and the Self-Service Options page.

Medical Review (MR):

In an effort to assist providers with the Targeted Probe and Education Process as well as self-audit activity, two new Medical Review provider resource tools were posted the CGS website.
- Home Health and Hospice Targeted Probe & Educate (TPE) Post Probe Education Call Tool
- Ambulance Services Checklist Tool
In response to provider feedback regarding clarity of reason for medically reviewed denied claims, Medical Review updated review results letters to provide more detailed denial rationale information.
Our goal is to ensure you receive the most benefit from your medical review educational experience. That's why CGS's Medical Review educators updated processes in order to provide clear and consistent information, offering resources and tools, and answering and following up on provider questions.
You asked for more web based educational opportunities! Check out the recorded webinars on our website for many clinical educational opportunities including Additional Development Request (ADR) tips and specialties such as Chiropractic, Ambulance, and Podiatry! And stay tuned for more…
Here's all you need in order to always know the date you need to submit your Additional Development Request (ADR) documentation. Access the Additional Development Request Timeliness Calculator and determine the date your documentation must be received by CGS.

myCGS Web Portal:

CGS is continually working to enhance our provider web portal based on your feedback. Here are a few of our recent enhancements.

Additional functions were added to the Claim Status page that allows you to:
- Submit a Redetermination (1st level of appeal)
- Request a Part B Reopening of the claim
- Respond to a request for additional documentation
- View CARC and RARC Codes and definitions
- Ask questions regarding the claim
The Medical Review (MR) Dashboard was developed to quickly identify MR additional documentation requests (ADRs). Under the Medical Review tab, review the ADR status, select a claim number to receive detailed claim information beginning at the point of the ADR pending to the medical review status, outcome, and allowing you to request a redetermination (1st level of appeal).
The Eligibility tab was enhanced to allow immediate access to your patient's history to see if Medicare Diabetes Prevention Program (MDPP) services were provided and helps you determine the next available date for certain MDPP services.
The Eligibility tab was enhanced to allow access to diagnosis codes associated with Medicare Secondary Payer (MSP) insurance type such as worker's compensation, automobile, and liability situations.
A new myCGS STATUS button was added to the top right of the Part A, Part B, and HHH website. When the myCGS STATUS button shows green, the web portal is up and running normally, yellow means there's an issue with some aspect of myCGS and when it shows as red, the myCGS web portal is not functional. Simply click on the button to access details of the issue.

Access the December 19, 2018, myCGS Enhancements Webinar recording for additional information.

Provider Contact Center (PCC):

No more searching for our contact number! For easy access, we made the telephone numbers to the PCC and to call the Interactive Voice Response (IVR) system available on the top of every Web page.
We know the new Medicare Beneficiary Identifier (MBI) format can be difficult to enter when using the Interactive Voice Response (IVR) or the Computer Telephone Integration (CTI). Therefore, we created the IVR and CTI Converter Tools which converts the beneficiary's name and Medicare number for easy entry on your telephone keypad.
In addition to the monthly PCC trainings set aside for our customer service representatives (CSRs), we continually review the top 10 telephone inquiries and have update internal tools to improve CSR consistency and 1st call resolution to better serve you.

Provider Enrollment:

CGS is continually strives to make the provider enrollment process a smooth process for providers. Therefore, we have focused on our communication to you and developed educational tools and resources.

Communication
- Provider Enrollment (PE) staff have reached out to Part A providers with high development rates to ensure understanding and to promote timely and accurate submissions and enrollment.
- Upon completion of the enrollment process, PE staff will randomly call providers to measure how the overall experience was and to ensure any questions are answered.
- The provider enrollment acknowledgement letters were updated to improve overall understanding of the purpose of the letter and the information provided to establish clear expectations through the enrollment process.
- Email communications were updated to ensure subject lines are more specific as to the reason for the communications and to promote timely responses.
Tools and Resources
- Two new job aids were developed to assist providers with Sections 5 and 6 of the CMS-855A and 855B enrollment applications and to define authorized and delegated officials.
  - Organizational Structure Application Requirements
  - Authorized and Delegated Officials
- The job aid, "What to Expect When Enrolling was developed to provide a high level overview of the enrollment process along with expected timeframes for completion of certain enrollment steps.
- Top enrollment application errors are analyzed and monthly data is posted to our website with tips to ensure accurate and complete submission.
- You can now see what the average enrollment application cycle times. This allows you to know each day how long it takes us to complete work.

Provider Outreach and Education (POE):

Have you noticed our enhanced webinars and ask-the-contractor teleconferences? In order to answer questions on the spot, we have added operational area subject matter experts to our webinars! We also now give you the opportunity to ask questions when registering for an event. This has allowed us to ensure we include all information you feel is important and have answers ready!
If you frequently visit our Calendar of Events web page, you may have noticed that we have significantly increased our educational events offerings! We heard your feedback, and we are out and about! Make sure you stay up to date on where we will be next or what webinar topic we have coming…
Did you miss an event?? Don't worry! We have recorded and posted many of our previous webinars! Check them out at the top of the Calendar of Events page!
We are constantly enhancing our search engine in order to provide you the best results! In the past year, some of our enhancements included a language prediction tool that provides suggestions as you type in a search term, search misspelled words, a no results message and search tips to help you find exactly what you are looking for.

Coming Soon: 2019 MAC Satisfaction Indicator (MSI)

If you liked these changes recently made or have more to suggest, let us know!! It is because of your feedback that we were able to accomplish these improvements. The 2019 MAC MSI survey is coming in March and this is the best opportunity to share your opinion with CGS and CMS! Be on the lookout for the survey in the next few days!

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

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

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

Process Improvements Based On Your 2018 MSI Survey Feedback!

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