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.
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.
This 4th quarter release update discusses the items that will be addressed:
It includes the following changes:
• New Home Health and Hospice (HH+H) Region Contractor Numbers
• Returning the Total Number of Hospice Occurrences
• Returning Psychiatric Benefit Data
• Changes to Hospital EB03 Data Element
• Changes to Part B Plan Level Co-Insurance Data
I discussed the changes regarding the total number of previous hospice visits in a previous article, “HETS to Fix Hospice Prior Benefit Period Identification Issue”, this update will allow hospice agencies to determine when a face-to-face visit is required.
When this update is released during mid-October, according to the latest news, LPRD data will be provided if you include Service Type Code A7 in your 270 eligibility request and the patient is entitled to Medicare Part A. For those of you that need this information, make sure that either you can control the Service Type Codes sent in your HETS transaction request or that your vendor will send this code for you.
To try Payerlink, our HETS eligibility software, click here to start a free trial.
Learn more about what Payerlink can offer here.
–By Kalon Mitchell – President, MEDTranDirect