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Last Modified: 12/13/2017 Location: FL, PR, USVI Business: Part A, Part B

HETS application: QMB financial data and hospice occurrence count

The Centers for Medicare & Medicaid Services (CMS) released several changes to the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS), which went into effect November 4, 2017. The changes impact providers who use First Coast Service Options’ (First Coast’s) Secure Provider Online Tool (SPOT) to access eligibility data through HETS. The eligibility display in SPOT now includes a tab titled QMB, or qualified Medicare beneficiary.

QMB periods in the 271 will result in changes to non-QMB period 271 financial data

Financial data in the HETS 271 response now appears differently for non-QMB periods for Medicare beneficiaries that have at least one QMB period intersecting the current date and/or the calendar (years) of the date/date range of the 270 request. QMB periods are returned as separate entitlement periods with independent financial details. Non-QMB periods returned on the 271 response are adjusted to illustrate that they are separate from a QMB period. This change in display function allows providers to easily see when a patient is eligible for QMB and when they are not eligible, and the financial details associated with both cases.

Change to 271 hospice occurrence count

HETS 271 responses only include the hospice occurrence count if the Medicare beneficiary has Part A entitlement. If the Medicare beneficiary does not have Part A entitlement, the hospice occurrence count benefit is not returned on the 271.
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