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.