New Provider Resource Center
Are you a new Medicare Part B provider or staff member? CGS is here to help, and we welcome you to the Medicare program. Please take a tour of the New Provider Resource Center. CGS developed this page with you providers in mind and compiled resources from far and wide. Given these resources, your journey through the Medicare Part B world is sure to be simplified!
We encourage all providers to become familiar with the Centers for Medicare & Medicaid Services (CMS) website
and the CGS website to find answers and resources relevant to your Medicare needs.
TopEducation
The primary goal of the Provider Outreach & Education (POE) program is to reduce the Comprehensive Error Rate Testing (CERT) error rate by giving Medicare providers timely and accurate information they need to understand the Medicare program, be informed about changes, and submit accurate claims. Take advantage of Webinars, Ask-the-Contractor Teleconferences (ACTs), Face-to-Face Training, self-paced Online Education Courses (OECs) and more to stay abreast of Medicare changes and updates.
CMS hosts regular and ongoing teleconference calls for the provider community on various topics. Calls are free. We encourage providers to take advantage of these educational opportunities to receive Medicare information from CMS Subject Matter Experts. Register to receive notices about upcoming Open Door Forums on the CMS website.
Join the ListServ
By taking a few simple steps, you can register to receive immediate updates on all Medicare information, including Medicare publications, important updates, educational opportunities and so much more. ListServ is a free service that guarantees receipt of the latest Medicare news and other time-sensitive information. Sign up for the topics and categories of interest to you.
Self-Service Technology- myCGS, IVR, and Customer Service
There are instances when a Customer Service Representative may not be available to assist with your inquiry. CGS requires providers to use Self-Service Technology for simple transactions, such as eligibility, deductible, Medicare Secondary Payer information, claims status, and outstanding check information. This allows our Customer Service Staff to be available when you need dedicated assistance for your complex issues. If your inquiry cannot be resolved through self-service technology, you may reach a customer service representative during normal business hours.
myCGS is the latest in self-service technology, offering the providers the ability to check claim status, eligibility, Medicare Secondary Payer information, Part B Deductible/Therapy Cap limitations, remittance notices, and financial information.
To register for this free web portal, please see:
The IVR is the telephone information system, and is available during and outside normal customer service hours, with brief periods of downtime for system maintenance and mainframe availability. Use the IVR to order duplicate remittance notices, as well as obtain the Medicare Part B deductible status, eligibility, Medicare Secondary Payer information, fee schedule information, denial reasons, outstanding check amounts, National Provider Identifier (NPI) and Provider Transaction Access Number (PTAN) validation and other claim processing information.
Please Note : You will need your billing NPI, PTAN, and the last five digits of your company's tax identification number (TIN) in order to utilize myCGS, the IVR, or when speaking to a Customer Service Representative.
For complex inquires that cannot be handled via the IVR and require the assistance of a Customer Service Representative, providers may call our Provider Contact Center.
- 1-866-276-9558
The Online Help Center allows you to submit inquires electronically to our customer service staff. It is important to note that you should not submit inquiries or comments through this system that contain sensitive personal information (e.g., social security numbers, tax ID numbers, beneficiary numbers, claim information, etc.) as this method of submitting an inquiry is unsecured and unencrypted. In addition, also note that it make take up to 45 days to respond to your electronic inquiry.
Part B Online Help Center
Electronic Data Interchange (EDI)
Requirement for Electronic Claim Submission
Submitting claims electronically reduces the reimbursement time by half and improves cash flow. For electronic claims, the minimum amount of time Medicare Contractors must hold claims before releasing payments is only 14 days. Paper claims have a 29 day payment floor from the date of receipt. We encourage all providers to take advantage of the benefits of EDI.
The Administrative Simplification Compliance Act (ASCA) requires Medicare claims to be submitted electronically. There are a few exceptions to this requirement. Please complete the Self-Assessment for ASCAin order to determine your qualifications. CMS Medicare Learning Network (MLN) Matters article MM3440
has more detail regarding ASCA certification.
Free software
We offer free software in order to submit your Medicare Claims electronically. PC-ACE Pro32 allows you to enter patient information, claim information, procedure file information, and create summary reports from submissions of electronic claims. Details of the software, including download information, are available at the following links:
Printing Remittance Advices (RAs)
Medicare Remit Easy Print (MREP) software is free and allows you to view and print HIPAA-compliant Remittance Advices (RAs). You may view and print as many or as few claims from each RA as you like. This will be especially helpful when you need to print only one claim from the remittance advice when forwarding the claim to a secondary payer. This software can save you time resolving Medicare claim issues.
More Information about EDI
These benefits and other valuable resources such as EDI contact information are available at the following links:
Forms
In an effort to simplify your transactions with Medicare, CGS offers the convenience of a one-stop shop for all the Part B Forms. Forms available from this link include the Reopening Adjustment Request Form, Redetermination Request Form, Offset Request Form, Overpayment Refund, a link to all CMS Forms and more.
Frequently Asked Questions (FAQs)
You have questions; CGS has answers! Choose from a variety of topics, including Electronic Data Interchange, Medicare Secondary Payer, CMS FAQs and more.
Claim Submission
Our goal is to help you submit claims correctly the first time. We are continually adding resources and educational opportunities geared toward identifying common claim submission errors and resolving such issues. The 'Claims Processing' link on our website provides resources such as: the Claim Submission Errors Manual, Crossover Claim Resources, Interactive Voice Response (IVR) System User Guide, the Modifier Finder Tool, and more.
Modifier Finder Tool
We often receive inquiries from providers about claim denials and proper modifier usage. To better assist with these types of inquiries, CGS designed the Part B Modifier Finder tool to aid Medicare providers in using modifiers correctly. You may search this database by modifier, keyword, or, if you wish, you may also view the entire listing of modifiers, their definitions, and additional billing information by selecting the "Show all Modifiers" option.
Give the Modifier Finder Tool a try:
Medicare Claim Review Programs and Bundling Edits
National Correct Coding Initiative (NCCI) edits, Medically Unlikely Edits (MUEs), Comprehensive Error Rate Testing (CERT) program, Recovery Audit Contractor (RAC), and the CGS Medical Review (MR) Department: CGS encourages providers to become familiar with these review programs as all claims are subject to review by at least one or more of these programs.
Refer to the CMS publication "Medicare Claim Review Programs: MR, NCCI edits, MUEs, CERT, and RAC
" for more information.
National Correct Coding Initiative (NCCI) & Medically Unlikely Edits (MUEs):
National Correct Coding Initiative (NCCI) edits are designed to promote correct coding by identifying CPT and HCPCS codes that have component parts (other CPT and HCPCS codes) and code combinations that are mutually exclusive. NCCI is a national initiative, and code pairs associated with NCCI edits are available on the CMS website. Edits are updated as often as quarterly, and there are exceptions allowed for some code pairs.
- Column I codes identify the major procedure ("parent codes"), and the associated Column II codes are the component codes.
- Code pairs with indicator "0" may not be reimbursed separately.
- Code pairs with indicator "1" may be reimbursed separately if documentation supports that the service is separately identifiable and medically necessary. For exceptions to NCCI edits: submit the appropriate modifier and maintain supporting documentation. Refer to the CGS Modifier Lookup tool for more information.
Medically Unlikely Edits (MUEs) are also a national initiative and were designed to reduce errors on submitted claims. MUEs set the maximum units of service providers would report in most circumstances for a single beneficiary on the same date of service. Not all codes have MUEs. Most MUEs are published; however, CMS does not publish all MUE values.
More information about NCCI and MUE, and the edits associated with both programs, is available on the CMS website.
Comprehensive Error Rate Testing (CERT) Program
The Centers for Medicare & Medicaid Services (CMS) developed the Comprehensive Error Rate Testing (CERT) program to produce national, contractor-specific, and service-specific paid claim error rates. Find CERT information and resources here.
The CERT Claim Identifier Tool was allows you to obtain the results of their CERT review for your office or practice. You may search this database by using the Claim Identifier (CID).
Medical Review
Do you have questions about the Medical Review process, how to contact the Medical Director, where to find your Local Coverage Determinations (LCDs), or documentation tips and guidelines? Check out the Medical Review link for more information.
Recovery Auditor (RA)
The Medicare Modernization Act of 2003 (MMA) mandated that the Centers for Medicare & Medicaid Services (CMS) establish the Recovery Audit Contractor (RAC) program as a three-year demonstration. The demonstration began March 2005 in California, Florida, and New York. In 2007, the program expanded to include Massachusetts, Arizona, and South Carolina before ending on March 27, 2008. The success of the demonstration resulted in the passage of legislation in the Tax Relief and Healthcare Act of 2006, Section 302, which required CMS to establish a National RAC Program by January 1, 2010. Recovery Audit Contractors are now known as Recovery Auditors (RAs). The RA for each jurisdiction (state) is determined based on where the services were rendered.
Region B RA
States - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
CGI Federal Inc.
Contact Information
Telephone number: 1.877.316.7222
CGI Federal website
E-mail address: racb@cgi.com
CMS Resources, Helpful Links, and Sites to Bookmark
There are many helpful resources available on the CMS website. We have identified some of the best resources on this site for you; use this list of Top Links and Sitesto access our favorites. Tip: bookmark these links in your browser.
Remittance Advices and Payments
Remittance Advices: At first, you may wish you had a secret decoder ring to decipher your Medicare Remittance Advices (RAs).
- Codes on your RAs are the keys to deciphering payments, denials, and other important information about your submitted claims. RAs include two types of codes that explain how your claims were processed: Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs). Access the Washington Publishing Company's websitefor a complete list of CARC and RARC codes.
Payments
Medicare reimburses many (but not all) types of services based on fee schedules.
- The Medicare Physician Fee Schedule (MPFS) is the basis for reimbursement for many services.
- Look up the MPFS amounts and other helpful reimbursement information for specific CPT and HCPCS codes on the CGS website (using our helpful tool) or directly from the CMS website.
- The CGS web article "Medicare Physician Fee Schedule: How Are Fees Calculated?" explains how MPFS amounts are calculated.
- Other fee schedules used to calculate reimbursement for Medicare claims include:
- Ambulance Fee Schedule
- Ambulatory Surgical Center Fee Schedule
- Clinical Laboratory Fee Schedule
- Reimbursement for drugs & biologicals: Average Sales Price (ASP)
- Ambulance Fee Schedule
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