Common Working File
Common Working File Edit Causing Incorrect Payments on Some LUPA Claims
The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12085 – Correction to Period Sequence Edits on Home Health Claims. The CR addresses an edit in the Common Working File that bypasses period of care sequencing on Low Utilization Payment Adjustment (LUPA) claims. Before the implementation of the Patient-Driven Groupings Model […]
Read MoreFull Common Working File Eligibility Sunset Due by December 2021
Given the historical reliance of hospice providers on the Common Working File (CWF) for eligibility queries, the National Association for Home Care & Hospice (NAHC) has been closely following developments related to the Centers for Medicare & Medicaid Services’ (CMS’) planned phase out of access to the CWF for eligibility queries (see HERE and HERE). […]
Read MoreCMS Updates Home Health Claim Processing Instructions for Unsolicited Responses
The Centers for Medicare & Medicaid Services (CMS) recently updated the claims processing instructions for Medicare Administrative Contractors (MACs), including instructions for processing multiple unsolicited responses on the same home health claim. Prior to the implementation of PDGM (Patient Driven Groupings Model), there was no need for multiple unsolicited responses to be processed during the […]
Read MoreRecommendations and Clarifications for HHAs on the No-Pay RAP
Beginning January 1, 2021, home health agencies (HHAs) will be required to submit a request for anticipated payment (RAP) that will be paid at 0 percent, prior to each claim. The Centers for Medicare & Medicaid Services (CMS) finalized the No-pay RAP policy in the CY 2020 Home Health Prospective Payment System Rate Update rule. […]
Read MoreAttention Billers: Medicare Secondary Payer Problem With HETS
The Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MACs) are aware of a problem with the HIPAA Eligibility Transaction System (HETS) Medicare Secondary Payer (MSP) data received from the Common Working File (CWF). The MACs’ eligibility systems/portals that receive MSP data from HETS may be affected by this issue. Due […]
Read MoreCMS to Shutter Common Working File for Eligibility Queries Effective February 1, 2020
The Centers for Medicare & Medicaid Services (CMS) has been working over recent years to migrate queries related to benefit eligibility from the Common Working File (CWF) and to establish the HIPAA Eligibility Transaction System (HETS) as the single source for beneficiary eligibility transactions. The National Association for Home Care & Hospice (NAHC) has been […]
Read MoreMovement to HETS as Sole Source for Eligibility Queries on Horizon
CWF: 3rd and later hospice benefit periods not calculating correctly In recent years, the Centers for Medicare & Medicaid Services (CMS) has taken steps to transition providers away from direct queries to the Common Working File (CWF) and toward the HIPAA Eligibility Transaction System (HETS) as the single source for beneficiary eligibility transactions. Earlier this […]
Read MoreCMS Proposes to Require a Notice of Admission
The Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate the advance, split percentage payments for all home health agencies (HHAs) in 2021. Therefore, agencies will no longer submit Requests for Anticipated Payment (RAPs) beginning January 1, 2021. The RAP submission opens a home health prospective payment system (HHPPS) episode in the CMS […]
Read MoreOffice of Inspector General Adds New Items to Home Health Work Plan
The Office of Inspector General (OIG) work planning is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues. A Work Plan was developed and is available to the public. It is updated monthly with new issues. In January 2019, there are two new issues of […]
Read MoreNew Edit for Hospice Medicare Claim Processing
The Centers for Medicare & Medicaid Services (CMS) released Change Request (CR) 11049/Transmittal 4187, Ensuring Only the Active Billing Hospice Can Submit a Revocation, which implements a new edit for hospice claims received on or after July 1, 2019. Currently, the Common Working File (CWF) will allow Notices of Revocation/Termination (NOTR – Type of Bill […]
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