With Medicare Open Enrollment right around the corner, now is the best time to get ready for changes in your patients’ eligibility data. Unfortunately, the system is far from perfect, and it’s highly unlikely your patients are going to notify you about that Medicare Advantage plan they tacked on at the last minute. You think you’re sending a perfectly billed claim out the door, only to be met with a biller’s least favorite word…REJECTED!
Just because you’re used to something doesn’t mean you have to like it. Now that Notice of Election (NOE) has to be submitted within five calendar days of admission date, you’ve probably had to make some changes to how you bill. There’s no getting around it. If your NOE is submitted and accepted by CGS outside of the five-day window, it’s no longer considered timely.
In case you were unaware of what this means, if an NOE isn’t timely-filed, Medicare will not pay for the days of hospice care from the hospice admission date to the date the NOE is accepted by the Medicare contractor. These days will be your liability, and you won’t be able to bill the beneficiary for them.
Are you ready for the CWF to HETS transition?
CMS will terminate access to CWF eligibility queries through HIQA, HIQH, ELGA, ELGH and HUQA later this year. When this transition occurs, Part A providers will undergo a huge change in how they verify Medicare eligibility. It’s essential that you’re ready!
The change over to the HIPAA Eligibility Transaction System (HETS) will require your intake staff to modify workflow procedures and learn a new computer interface. By transitioning early, you’ll be able to make the change with minimal interruption to your daily procedures. This change can become even easier if you use MVP Live to check Medicare eligibility.