Self-service tools are convenient and available whenever you need them - 24 hours a day, seven days a week. Many questions can be answered quickly and easily by our self service tools.

CGS DME MAC JURISDICTION B & C PROVIDER OUTREACH & EDUCATION

Self-Service Guide

PAGE 2

CGS WEBSITEOur website is the place to find all of our educational resources and self-service tools discussed below. You might even say that https://www.cgsmedicare.com is the ultimate self-service tool!

myCGSOur online portal offers the most detailed information on everything from beneficiary eligibility to claim processing and payment information. myCGS is a separate portal within our website for the secure delivery of protected health information, so a separate authorization process is required in order to access myCGS. Information available includes:

• Claim information• Beneficiary information• Payment information• Redetermination status

and submission

• Reopening status and submission• CMN status• Duplicate remittances• Prior Authorization and ADMC

status and submission

Availability:• General information: 24 hours a day, seven days a week• Data related to claims, CMNs or beneficiaries available:

- Mon - Fri: 7:00 a.m. – 10:00 p.m. EST, 6:00 a.m. – 9:00 p.m. CST - Sat: 7:00 a.m. – 5:00 p.m. EST, 6:00 a.m. – 4:00 p.m. CST

• Only available in the U.S. and its territories• Downtimes during regularly scheduled maintenance times will be

communicated via ListServ and upon calling.

Jurisdiction B: https://www.cgsmedicare.com/jb/mycgs/index.html

Jurisdiction C: https://www.cgsmedicare.com/jc/mycgs/index.html

INTERACTIVE VOICE RESPONSE (IVR)Our automated phone line provides a variety of information including:

• Claim information• CMN status

• Beneficiary information • Payment information

• Redetermination status

Availability:• General information: 24 hours a day, seven days a week• Claim and eligibility information:

- Mon - Sat: 7:00 a.m. – 10:00 p.m. EST, 6:00 a.m. – 9:00 p.m. CST• Downtimes during regularly scheduled maintenance times will be

communicated via ListServ and upon calling.

PAGE 3

Jurisdiction B: https://www.cgsmedicare.com/jb/cs/ivr.html

Jurisdiction C: https://www.cgsmedicare.com/jc/cs/ivr.html

CGS WIZARDCGS Wizard allows you to use the 14-digit Claim Control Number (CCN) to get easy-to-read denial reasons and resources on all processed claims - 24 hours a day, seven days a week.

Jurisdiction B: https://www.cgsmedicare.com/medicare_dynamic/jb/mrwizard/denials.aspx

Jurisdiction C: https://www.cgsmedicare.com/medicare_dynamic/jc/mrwizard/denials.aspx

ONLINE TOOLSThese tools are conveniently grouped together under the “Online Tools & Calculators” menu available on every page of https://www.cgsmedicare.com.

Advance Beneficiary Notice of Non-Coverage Tutorial – NEW!Point-and-click tool shows you exactly what information is needed in each section of the ABN form.

Advanced Modifier Engine – NEW!The Advanced Modifier Engine (AME) helps you bill the proper HCPCS codes and modifier combinations for DMEPOS in specific billing scenarios.

ADR Online ToolEnter the Additional Documentation Request (ADR) number for details about the requested information.

ALJ Appeals Status RequestCheck the status of your appeal hearing before the Administrative Law Judge (ALJ).

Appeals Decision Tree Provides guidance as to whether a redetermination or reopening is the correct next step.

CERT Claim Identifier ToolSearch the database for results of your CERT review.

CGS MedicareSM – NEW & IMPROVED!Access and share Dear Physician Letters, results of CGS Wizard inquiries, fee schedules, and more from your phone or tablet.

PAGE 4

Claim Denial Resolution ToolSearchable database of Reason and Remark codes found on the remittance message which provides detailed denial explanations, as well as possible causes and resolutions.

CMS 1500 Claim Form Instructions ToolIdentifies which information is required in each section of the claim form.

Condition of Payment Prior Authorization Lookup ToolFind out which codes are subject to Condition of Payment Prior Authorization.

DMEPOS Consolidated Billing ToolDetermine if item is payable for beneficiaries in a skilled nursing facility, home health episode, or hospice.

HCPCS LookupFind descriptions for all HCPCS codes.

IVR Beneficiary Name-to-Number ConverterConvert the beneficiary’s name to number for faster input to the Interactive Voice Response line.

KE & KY Modifier ToolDetermine the appropriate use of the KE and/or KY modifiers.

KX TableWhen and where to use the KX modifier.

Medicare Beneficiary Identifier (MBI) ConverterConvert the 11-digit alpha/numeric Medicare Beneficiary Identifier (MBI) to the characters needed to enter into your telephone keypad when accessing information via the Interactive Voice Response (IVR) system.

Modifier Finder ToolSearchable database for modifier or keyword.

MSP LookupDetermine if Medicare is the primary or secondary insurer.

Ordering/Referring Provider Denial Job AidProvides assistance in correcting claim rejection/denial due to a missing, incomplete or invalid ordering provider name and/or NPI.

Positive Airway Pressure (PAP) ToolGet information about a particular HCPCS code for PAP devices.

Power Mobility Devices Denial Help AidView categories of denials associated with claims for power mobility devices.

PAGE 5

Power Mobility Devices Weight Requirements ToolWeight requirements and coding options.

Provider Enrollment, Chain, and Ownership System (PECOS)Link to enrollment tool and information.

Same/Similar Tool – NEW!Shows HCPCS that may cause a denial if billed with a particular base item.

Therapeutic Shoes for Persons With Diabetes Activity Timeline – NEW!Documentation and activity timeline regarding diabetic shoes.

CALCULATORSLet our calculators do the math for you!

ADR Timeliness Calculator Assists in determining the date ADR documentation must be received in order to meet the time frame for submission.

Appeals Time Limit Calculator Need to submit a Redetermination Request, but aren’t sure whether it meets the 120-day timeliness requirement? This tool does the calculating for you.

CPM Device Date Span CalculatorDetermines the date span for DME MAC coverage of CPM devices based on the dates of surgery, onset, and discharge.

Claims Timely-Filing CalculatorCalculates the claim timely-filing limit for the billed service(s).

End Stage Renal Disease 30-Month Coordination Period Calculator – NEW!This tool calculates the 30-month coordination period prior to Medicare becoming the primary insurance for ESRD beneficiaries.

Enteral Nutrition CalculatorDetermines the proper units of service required to submit a claim for Medicare payment consideration.

MSP Line Level Calculator Assists you in determining the line-by-line claim payment for covered services when Medicare is the secondary payer.

Nebulizer Medication CalculatorEnter the strength of the ordered drug, the size of the vial dispensed (if applicable) and the frequency the medication is taken daily, and the calculator will display the maximum number of units that can be billed in a 30- or 90-day period.

PAGE 6

Overpayment Interest Calculator – NEW!Enter the date on the Demand Letter, the date the check is being mailed, the overpayment amount and the interest rate to find the total amount due.

Parenteral Nutrition Solution Lipids (B4185) CalculatorHelps you calculate the correct units of service for HCPCS code B4185.

Online Tool & Calculator References

Jurisdiction B: https://www.cgsmedicare.com/jb/help/tools.html

Jurisdiction C: https://www.cgsmedicare.com/jc/help/tools.html

FORMSRequired and suggested forms can be found conveniently listed on one page, accessible on every page of the website.

Jurisdiction B: https://www.cgsmedicare.com/jb/forms/index.html

Jurisdiction C: https://www.cgsmedicare.com/jc/forms/index.html

FUNDAMENTAL SELF-SERVICE TOOLSThe core of all our self-service tools – and of Medicare policy in general – are available on our website under “News and Publications.”

Supplier ManualThe manual provides information and instructions for DMEPOS Medicare processes from enrollment to acronyms and abbreviations, and everything in between.

Jurisdiction B: https://www.cgsmedicare.com/jb/pubs/sup.m.an/index.html

Jurisdiction C: https://www.cgsmedicare.com/jc/pubs/sup.m.an/index.html

Local Coverage Determinations (LCDs) LCDs provide information regarding reasonable and necessary requirements for DMEPOS items, including information on documentation, refills, HCPCs codes, modifiers and more.

Jurisdiction B: https://www.cgsmedicare.com/jb/coverage/lcdinfo.html

Jurisdiction C: https://www.cgsmedicare.com/jc/coverage/lcdinfo.html

Policy Articles Policy Articles are linked at the bottom of every LCD. They contain important, policy-specific payment rules and related information.

DON’T FORGET!

PAGE 7

Standard Documentation RequirementsAll claims submitted to DME MACs must meet certain standard requirements outlined here and linked from all LCDs.

ONLINE EDUCATION CENTERNew Supplier Welcome CenterHelpful information on getting started with Medicare.

Dear Physician Letters and Physicians, Are You Ordering….Articles from our medical directors directly to physicians about documentation issues.

Online Education CoursesBoth general and policy-specific modules for learning at your own pace, at your convenience. Available 24/7.

Video EducationVideos from our medical directors.

Jurisdiction B: https://www.cgsmedicare.com/jb/education/index.html

Jurisdiction C: https://www.cgsmedicare.com/jc/education/index.html

JURISDICTION B

JURISDICTION C

Originated March 26, 2019 | Revised July 1, 2020 | © 2020 Copyright, CGS Administrators, LLC

JB: http://www.cgsmedicare.com/jb/index.html JC: http://www.cgsmedicare.com/jc/index.html

myCGS

Online Tools & Calculators

CGS GoMobile

Claim Submission

Medial Review

Medicare Beneficiaries

Fee Schedules

Local Coverage Determinations

Education

CERT

FAQs

Forms/Checklists/Guides

News & Publications

Customer Service

CGS Contact Information

Helpful Links

Other Contractors