Skip to Main Content

Print | Bookmark | Email | Font Size: + |

February 2, 2023

Medicare Provider Alert: Your Responsibility When Using Billing Companies and Outsourced Agencies

The Centers for Medicare & Medicaid Services (CMS) requires providers, billing companies, and outsourced agencies to use the Interactive Voice Response (IVR) systemPDF or the myCGS Web Portal to verify eligibility and claim status.

Recently, we have noticed an increase in inquiries from billing companies and outsourced agencies, where some are failing and/or refusing to use the IVR or myCGS. Additionally, some of these individuals are not familiar with basic Medicare coverage or billing requirements. A pattern we also recognize is generic, scripted questions that are asked repeatedly with the same exact response each time, and questions that can easily be answered by reviewing the Remittance Advice, using myCGS, the IVR and/or our website.

When the PCC recognizes a pattern of calls where a billing company or outsourced agency is not using the IVR or myCGS for eligibility or claim status, CGS may contact the billing provider to discuss these activities, as they tie up the PCC phone lines unnecessarily by increasing the amount of time our staff spends on a call.

Remember – you contract with these companies, and they represent your practice. If you use a billing company or outsourced agency you can help by making sure that you provide them with access to the Medicare remittance notices and other notifications (e.g., appeals letters, requests for additional documentation, etc.) for services and claims they work. It will also help to ensure they:

  • Employ staff that have knowledge of the Medicare program
  • Are aware of and follow Medicare rules and regulations
  • Have access to and understand how to use the IVR and/or myCGS to verify patient eligibility and check claims status
  • Take full advantage of the other self-service options available on the CGS website

CGS provides several new staff training materials on our Education & Events webpage, including:

Providers are also reminded that the responsibility to guard Medicare beneficiary Protected Health Information (PHI) lies with the provider and not with the billing company or outsourcing agency. If a PHI disclosure were to occur, the provider would be held liable for any financial penalties related to that disclosure. It is important that you verify adequate processes are in place to ensure PHI is protected.


26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved