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NAHC Report: Issue# 2375 2/19/2014
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
CMS to Further Delay Termination of Access to CWF Queries – Working to Replicate CWF Hospice Benefit Period Format in HETS
CMS Clarifies ABN Instructions for Dually Eligible
For Your Information: CMS’ Hospice Item Set Training Videos Available Online
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CMS to Further Delay Termination of Access to CWF Queries – Working to Replicate CWF Hospice Benefit Period Format in HETS

As part of a recent MLN Matters article, MLN Matters SE1249 Revised, the Centers for Medicare & Medicaid Services (CMS) announced that its intended April 1, 2014, termination of access to Common Working File (CWF) eligibility queries in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE), often referred to as the HIQA, HIQH, ELGA and ELGH screens and HUQA, will be further delayed. 

CMS is continuing to make modifications to the HIPAA Eligibility Transaction System (HETS) so that, among other things, it returns hospice benefit period information in the same format as is currently available in the CWF.  No future termination date has been set but the article indicates that CMS will provide at least 90 days advance notice of the new termination date.

Providers should be preparing to make the transition to HETS for eligibility inquiries.  Discontinued access for CWF eligibility queries will not affect the use of DDE to submit claims or to correct claims and will not impact access to beneficiary eligibility information from Medicare Contractors’ Interactive Voice Response (IVR) units and/or Internet portals. 

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CMS Clarifies ABN Instructions for Dually Eligible

The Centers for Medicare & Medicaid Services (CMS) has issued change request (CR) 8597 which provides corrections and clarifications to the Advanced Beneficiary Notice (ABN) instructions in the Claims Processing Manual. 

The CR clarifies instruction for home healthcare providers when completing the ABN for dually eligible beneficiaries.  The option boxes on the ABN form CMS-R-131, that replaced the HHABN form CMS-R-296, do not provide a clear explanation for dually eligible beneficiaries when Medicaid will be the primary payer for services because they do not meet Medicare coverage criteria. The language on the form is structured so that beneficiaries could mistakenly believe they will be financially liable for services when Medicare will not pay, regardless of the availability of other payer sources. 

CMS will permit agencies “to direct the beneficiary to select a particular option box to facilitate coverage of other payers” which is an exception to the ABN general instructions. The CR also provides instructions on which option boxes should be completed and additional information that can be provided when the state either does or does not require a claim be sent to Medicare for denial prior to billing Medicaid.

To view the CR, please click here.

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CMS’ Hospice Item Set Training Videos Available Online

CMS has posted videos of its recent Hospice Item Set trainings that occurred February 4 and 5 in Baltimore, MD.

To access the most recent training videos, please click here.

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