Cahaba University

Welcome to Cahaba. If you are new to Medicare, or to billing Medicare claims to Cahaba, this page contains basic information and resources to get you started. As a provider, you are held accountable for understanding information you receive from the Centers for Medicare & Medicaid Services (CMS) and Cahaba. Please share this information with your staff as appropriate.

Home health and hospice providers should become familiar with all of the resources listed on this page as a means to research issues and verify the answers to their Medicare questions prior to calling the Provider Contact Center for assistance.

If you submitted your completed 855-A form and received a letter from Cahaba welcoming you as a Medicare-certified provider, please proceed on with the steps detailed below.  If not, please review the steps on the Medicare Provider Enrollment Web page on becoming a Medicare-certified provider.

 

To Get Started

Step 1: Enroll in the Cahaba E-mail Notification Service and CMS Listservs

These are the primary means used to communicate new or changing Medicare information with providers.  Sign-up so that you are always “in the know” when it comes to Medicare.

 

Step 2: Become familiar with the Cahaba and CMS Web Sites

Take the Cahaba Web site Tour, which gives you a brief overview of our Web site and shows you where to find important information and resources.

Please note the “Search” function on the Web site.  Use this to receive a listing of information posted to cahabagba.com on various Medicare topics.

CMS Web site

Familiarize yourself with important information found on the CMS Web site.

• Official site for CMS, the federal agency that administers Medicare.
• Current updates and information regarding Medicare: http://www.cms.gov/
• Medicare Learning Network (MLN) Product: Guided Pathways to Medicare Resources for Medicare Fee-for-Service Health Care Professionals
• Become familiar with the information accessible from the “main pages.”
  • Medicare
  • Regulations and Guidance 
  • Outreach & Education 
  • Resources & Tools 
  • View Provider Specific Web pages

The Cahaba Web site also contains “quick links” to Medicare information found on other Web sites, including the CMS Web site

 

Step 3: Enroll and Learn About Electronic Billing

Read the Electronic Billing Packet.  This packet provides you with information about submitting your claims electronically to Medicare. You must bill your claims electronically, unless you meet the exception for a small provider. 

Complete Electronic Data Interchange (EDI) Forms
You must submit the following forms to sign up to submit your claims electronically. The EDI forms must be completed online by typing your information directly into the application form.  Instructions are available on the EDI Forms Web page.  Once completed, print the application, obtain an authorized signature, and fax it to the Cahaba EDI Service fax number indicated on the form.

• EDI Services Part A Enrollment Application
• EDI Services Part A System Access Request

 

Step 4: Get Acquainted with Medicare

Below is a list of critical resources you will need for providing and billing Medicare-covered services. It is critical, and required by your Medicare conditions of participation, that you are compliant with this information. Consider bookmarking these Web addresses for future reference.

Calendar of Events

• 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 connection (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 Cahaba-sponsored events and details for how to register for partnering events.

Home Health & Hospice Medicare A Newsline

• Monthly newsletter published by Cahaba.
• Posted on this Web site.
• Provides updates, clarifications and/or corrections to Medicare guidelines, coverage and reimbursement.

CMS Online Manual System

• Published by CMS.
• Provides coverage, billing and reimbursement information for all Medicare providers.
• Only accessible on the Internet (exceptions are made for providers unable to access via the Internet).

CMS Guided Pathways Medicare Curriculum

Interactive Voice Response (IVR) Unit

• Automated self-service tool that assists home health and hospice providers with answers to various Medicare questions, including:
• • Beneficiary eligibility information (Medicare Part A or Part B enrollment dates; Medicare Secondary Payer (MSP) record effective/terminations dates; Medicare Advantage plan enrollment dates; home health episode dates; hospice benefit period dates, etc.)
  • Claim status information (beginning and ending dates of claim; total charges submitted on claim; status of claim; etc.)
  • General Medicare program information
  • Appeal rights information
  • Hours of operation

Provider Reimbursement Manual 

(This is available online in the paper-based manual format.  This is the only paper-based manual that providers should use.  All other information is found in the CMS Online Manual System.)

• Instructions on calculating Medicare payments.
• Instructions on submitting an annual Medicare cost report (MCR) to the fiscal intermediary.

Educational Materials

Access to provider specific materials: 

• Contains both detailed and quick reference materials.
• Newly Certified Home Health Provider or Provider Number Change

Local Coverage Determinations (LCDS) / Coverage

• Policies developed by Cahaba.
• Provide guidance concerning Medicare coverage and payment when no national policy exists.

Medical Review

• Progressive Corrective Action (PCA) principals.
• Provides information related to medical review prepay, and postpay activities, including the Additional Development Request (ADR) process.  
• Denial reason codes that apply to home health and hospice claims.
• Comparative Billing Report that compare your facility to your state and to the total claims processed by Cahaba for specific dates of service.

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.

Step 5: Complete the “New to Medicare” Learning Track

Step 6:  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.
  • Biller Checklist
  • Clinician Checklist

Page last updated: August 10, 2010

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