Home Health and Hospice New Provider Resource Center (2024)

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Home Health and Hospice New Provider Resource Center (1)

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) websiteHome Health and Hospice New Provider Resource Center (2). 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 FacebookHome Health and Hospice New Provider Resource Center (3) and LinkedInHome Health and Hospice New Provider Resource Center (4). In addition, sign up for the weekly MLN Connects®Home Health and Hospice New Provider Resource Center (5) 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 for a variety of educational, billing, and coverage information. Take the 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 siteHome Health and Hospice New Provider Resource Center (6).

The CGS web site also contains "Helpful Links" to Medicare information found on other Web sites, including the CMS web site.

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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.

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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.

  • 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.

  • Monthly newsletter published by CGS
  • Accessed from the "" 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 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 1Home Health and Hospice New Provider Resource Center (28) (CMS Pub. 15-1)

Provider Reimbursement Manual – Part 2Home Health and Hospice New Provider Resource Center (29) (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 ManualsHome Health and Hospice New Provider Resource Center (30).

  • 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.

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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.

  • Medicare Resources For New Billers
  • Medicare Resources For New Clinicians

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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.

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Updated: 11.29.21

Home Health and Hospice New Provider Resource Center (2024)

FAQs

What is the reason code 37363 for Medicare denial? ›

Reason Codes 39929 (claim level) and 37363 (line level) are indicating incorrectly that request for anticipated payment (RAP) claims have been submitted beyond timeliness limits. NGS is working with the U.S. Centers for Medicare and Medicaid Services (CMS) to resolve this error.

What is a burdensome discharge from hospice? ›

Burdensome transition is defined as hospitalization within two days of hospice live discharge, followed by hospice readmission within two days of hospital discharge, or hospitalization within two days of hospice live discharge with in-hospital death.

What is the difference between home health care and hospice? ›

Hospice provides comfort care to a patient with advanced illness when curative medical treatments are no longer effective or preferred. Home health care is curative, intended to help patients recover from injury or illness, or progress toward improved functionality.

How does CMS define hospice? ›

Hospice is a comprehensive, holistic program of care and support for terminally ill patients and their families. Hospice care changes the focus to comfort care (palliative care) for pain relief and symptom management instead of care to cure the patient's illness.

What is denial reason code 37236? ›

Reason Code 37236

Description: Claims are denied with reason code 37236 when the NPI and/or physician's last name submitted on the home health claim does not match the physician's information at the Provider Enrollment, Chain, and Ownership System (PECOS).

What is denial reason code 32243? ›

Reason code 32243 defines a home health billing transaction that was submitted without a 0023 revenue code line or a revenue code line for a visit was billed without charges.

What is the hospice scale 7? ›

Karnofsky Scale

8: Normal activity with effort; some signs or symptoms of disease. 7: Cares for self; unable to carry on normal activity or to do active work. 6: Requires occasional assistance, but can care for most of own needs. 5: Requires considerable assistance and frequent medical care.

How do you fight hospice discharge? ›

A beneficiary who disagrees with the termination of services may request an expedited determination to the Quality Improvement Organization (QIO). The QIO is responsible for notifying the hospice that the beneficiary has requested an expedited determination.

Why would you get kicked out of hospice? ›

Discharge for cause—according to the hospice's policy, the behavior of the patient or someone in the patient's home is disruptive, abusive or stands in the way of the hospice dispensing its duties to the patient.

Does hospice help with bathing? ›

Performed by or under the supervision of a licensed therapist. Hospice aides and homemaker services, including full coverage of a hospice aide to provide personal care services, including help with bathing, toileting, and dressing, as well as some homemaker services (changing the bed, light cleaning and laundry).

Does Medicare cover hospice and home health at the same time? ›

Medicare Part A (Hospital Insurance)—Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B (Medical Insurance)—Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

What does 3HC stand for? ›

2000 – Home Health and Hospice Care, Inc. granted its first wish to a hospice patient through the Angel Foundation. 2006 – Organization rebrands to 3HC.

Which two conditions must be present for a patient to enroll in hospice? ›

The minimum requirement is a reduced life expectancy of fewer than six months and a terminal illness diagnosis; some will also require the patient to discontinue any curative measures before starting hospice care.

What is the denial code for not covered by Medicare? ›

Non-covered charge(s). This item or service does not meet the criteria for the category under which it was billed.

What is Medicare reason code 34963? ›

A. Claims will return with reason code 34963 for one of the following reasons: The attending physician on claim page 03 is invalid. The attending physician NPI is present, but the first four digits of the last name do not match PECOS.

What is a Medicare medical necessity denial? ›

When this denial is received, it means Medicare does not consider the item that was billed as medically necessary for the patient. A CO 50 denial cannot be resubmitted. It must be sent to redetermination.

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