HETS to add Lifetime Psychiatric Remaining Days

Over the last several months, we have assisted customers in switching to the HETS (HIPAA Eligibility Transaction System) from DDE as customers prepare for the April 2014 elimination of eligibility data.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1249.pdf

I have discussed in previous articles about differences between these two systems, how they obtain their information, and how this impacts the ability of certain providers to verify Medicare patient eligibility information.

One item that has been mentioned often by our customers is the Lifetime Psychiatric Remaining Days (LPRD).  This value is available through DDE, but is not returned by CMS through the HETS ANSI 271 response.  We have many customers who use DDE exclusively for the purpose of looking up patients and getting this single value.  We have reported this to the HETS help desk and it appears that they are responding to the problem. Continue reading

Direct Data Entry (DDE) Security Upgrade Requirement

As most of you know, CMS allows providers direct access to the Common Working File (CWF) through DDE.  This technology has existed for many years and has evolved from remote terminals, modems and phone lines to terminal emulator software running on personal computers connected to the CWF through secure networks.

As this technology evolved, some providers and vendors implemented more modern solutions for their DDE connections, others stuck with existing systems.  Regardless of the technology, the functionality of DDE remained the same.  Once you get connected, everyone sees the same screens and has the same capabilities.  How you got connected made no difference, until now. Continue reading

Operating Rules Update – More Good News for Providers

As I promised in my last article, I am revisiting the subject of ERAs and the operating rule changes taking effect on 1/1/14.  In previous articles we discussed the benefit of universal availability of the ANSI 835 electronic remittance and how it can improve your revenue cycle management.

There are two more aspects of this rule that will benefit providers.  First, the rules include the establishment of timing criteria between the arrival of the payments and the availability of the 835.  This is referred to as the “three day rule”.  Basically, the rule states that the 835 and the EFT will arrive within 3 business days of each other.  It does not say which one will come first, but that when you get one of the transactions, the other will either have been sent already, up to three days in the past, or will arrive up to three days later.  This will help facilities match the check to the 835 and react quickly when either transaction is late. Continue reading

Leveraging Operating Rules to Improve the Remittance Posting Process

As I discussed briefly in a previous article, the Affordable Care Act (ACA) includes regulations to implement operating rules for transactions previously defined as industry standards.

http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/OperatingRulesforHIPAATransactions.html

These include the HIPAA transaction used by CMS and other major payers to provide detailed payment and adjustment information associated with checks or Electronic Funds Transfers (EFT). This electronic remittance standard is referred to as the ANSI 835.

The ACA defines “operating rules” as “the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications.”  In other words, the standards, like the ANSI 835, regulate the structure and content of the data being exchanged between two healthcare industry stakeholders, typically a payer and provider.  These operating rules deal with enforcing the use of these standards among all covered entities so that benefits can be achieved by building administrative systems depending on the universal existence of these transactions, delivered in a standardized manner. Continue reading