Hospices Brace for New CMS Five-Day Submission Requirement for the NOE

CMS announced the final rule for hospices regarding the timely filing of the NOE in transmittal 3032 sent out August 22.

In the document, CMS designates that a timely-filed NOE (Notice of Election) shall be filed within five calendar days after the hospice admission date.  This applies to the NOTR (Notice of Election Termination/Revocation) as well.  This regulation is effective for dates of services on or after October 1st.

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Previously, there were no regulations regarding the timing of submitting these transactions. The NOE and the NOTR are essentially claims submitted to CMS that do not represent any services being billed, but the execution or revocation of an agreement between the hospice and the beneficiary receiving their services. These agreements are normally executed in the field, away from the office, at the patient’s home or with representatives of their family. The NOE is used to notify CMS that the beneficiary has elected to change their relationship with Medicare and to accept all medical services related to a diagnosis through the hospice only from that point forward, until they elect to change this relationship. Continue reading

MEDTranDirect Introduces All Payer Eligibility

This upcoming weekend, effective 9/29/14, MEDTranDirect is releasing our new All Payer Eligibility Module to selected PayerLink customers.  This new module will allow you to execute eligibility transactions for payers other than Medicare.  This includes all state Medicaid programs and hundreds of commercial payers.


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Like the HETS system for Medicare, you can get real time results for these payers in seconds, reducing the errors associated with providing services and submitting claims without verified insurance information. Continue reading

Calculating the Potential Savings of Automating Administrative Transactions

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The cost of processing administrative transactions associated with health insurance claims is part of doing business as a healthcare provider and a health plan.  During the last fifteen years, HIPAA has established standards for conducting many of these transactions electronically.  The Affordable Care Act introduced Operating Rules that are making these transactions mandatory for health plans when providers request them.  In 2013, the claim status transactions (276/277) and the eligibility transaction (270/271) became mandatory standards.  In 2014, the 835 electronic remittance and the EFT became available to any provider requesting them from a health plan.  In addition, the ACA requires that these payment transactions occur within three days of each other and that standardized codes are used for certain types of adjustments and remarks. Continue reading