CMS turns away new applicants

Friday, November 30, 2007

WASHINGTON - Providers who want to start checking patient eligibility using CMS's online system are out of luck. The agency announced Oct. 12 that it has enacted a "temporary moratorium" on new applications for its Medicare HIPAA Eligibility Transaction System (HETS) 270/271. Those who already have "submitter ID numbers" can continue using the system.
CMS's timing couldn't have been worse, said Edward Kutt, president of Diabco, a vendor of eligibility software.
"We just got back from Medtrade with the names of more than 100 providers who are interested in our product," he said. "We also have a lot of contracts pending."
Vendors like Diabco, Brightree and Noble House pointed out the moratorium only affects their eligibility software.
CMS has enacted a moratorium before. Last year, the agency temporarily closed the door on new applications to address technical issues with the system.
But CMS failed to state a specific reason for the moratorium this time. The only hint: In a notice, the agency stated it was conducting an "intense evaluation."
Industry sources believe CMS could still be tweaking the system due to increasing demand.
"They're still investing significant time and energy to improve it," said Dave Cormack, CEO of Brightree, a software vendor.
Some industry sources fear CMS may have ulterior motives.
"It may have something to do with some providers running eligibility multiple times for the same patient, which our clients don't do often," said Richard Basch, director of marketing and sales for Noble House, a software vendor. "If a provider is over (a certain) threshold, then CMS could start to take action."
CMS also failed to state how long it would keep the moratorium in place.