CMS Issues Moratorium on HIPAA Eligibility Transaction System

BALTIMORE–In a system announcement sent Oct. 12, CMS said it is
conducting an “intense evaluation” of the Medicare HIPAA
Eligibility Transaction System 270/271 and has enacted a temporary
moratorium on the enrollment of new application users.

Although current and active submitters will be allowed to retain
their access, according to the announcement, “clearinghouse
submitters will be required to cease enrolling new customers
immediately.”

The announcement caught Edward Kutt, president of Diabco Medical
Billing Systems, by surprise. The company’s Me-First real-time
software allows providers to check patients’ Medicare eligibility
and see what portion of their deductible has not been paid.

“We have hundreds of users and we had a good Medtrade,” said
Kutt, estimating that more than 100 additional providers expressed
interest in the software at the recent trade show, “but this means
they can’t get involved.”

Kutt added that Medicare gave no indication of how long the
moratorium would last.

Telephone access will still be available to check eligibility,
Kutt said, “but it takes seven to 10 minutes to check on one
patient” using the phone system. His company’s software “can check
hundreds of patients in minutes,” Kutt said, noting that “it is
about automation and saving time when you have hundreds or
thousands of patients. It’s impossible to call every month to check
eligibility.

“I just hate to see providers lose the advantage of being able
to prevent denials and prevent loss of products,” Kutt continued.
“People [who] have already been enrolled will have a huge business
advantage over those that cannot get enrolled,” he said, adding
that if providers send a product out the door without verification
of benefits, “they might never get paid.”

“Another annoying thing is that [CMS] sent the e-mail on Oct.
12, and the moratorium is effective Oct. 12,” Kutt said. “That’s
really not fair. They should give us some lead time. Providers who
are interested in our product have had the door slammed in their
face.”

The CMS announcement also said submitters that have been
validated will have until Nov. 15 to implement HETS 270/271.
Submitters that cannot complete testing and move to production by
that date will have their trading privileges revoked until the
moratorium ends.

For questions, CMS gave the MCARE help desk phone number at
(866) 324-7315.