CMS lifts moratorium on eligibility system

Monday, March 31, 2008

WASHINGTON – Providers who want to start checking patient eligibility using CMS’s online system are back in business. On Feb. 1, CMS dropped its temporary moratorium on new applications for its Medicare HIPAA Eligibility Transaction System (HETS) 270/271.
“During the moratorium, we were still taking applications and putting them in a holding bin,” said Mark Blount, vice president of marketing for Brightree, a vendor of eligibility software. “We had in excess of 1,000 applications in the bin, and when CMS lifted the moratorium, we processed those right away. We’ve gotten another 200-plus applications since (Feb. 1). We didn’t miss a step.”
CMS enacted the temporary moratorium on Oct. 12. The agency has enacted a moratorium one other time, in 2006, to address technical issues with its system.
Vendors still don’t know why CMS enacted the Oct. 12 temporary moratorium. They suspect CMS plans on changing the way it handles eligibility requests, and the moratorium gave the agency time to prepare for the transition.
Whatever the reason, vendors were disappointed that CMS kept the temporary moratorium in place into 2008.
“The worst part was the moratorium going into January and February,” said Edward Kutt, president of Diabco, a vendor of eligibility software. “That’s when eligibility systems are so important. Providers want to check their deductible balances and for two months, they couldn’t, so they’re just now dealing with them. That’s causing some grief.” HME