If you’re 65 years old, about to be 65 years old, or if you know somebody who is, here’s a message for you: Don’t wait to sign up for, or change, Medicare insurance plans - poor planning, procrastination and missed deadlines expedite the aging process!

The Medicare Open Enrollment Period is October 15^th through December 7^th, and it’s time to make decisions about your future now - changes made during this period will take effect January 1^st of next year.

Here’s a brief overview of some upcoming deadlines:

• Part A, B, D – Enrollment begins 3 months before and up to three months after you turn 65.
• Medicare Supplement Insurance (Medigap) – Medigap open enrollment lasts 6 months and begins when 1) You are 65 or older 2) Have enrolled in Medicare.
• Working past age 65 – You must enroll within 8 months of being unemployed or dropping your health plan.

What each part means:

Part A – Hospital insurance: Covers inpatient care, hospice, home health and skilled nursing care.

Part B – Medical insurance: Covers outpatient care, preventative services and medical equipment such as wheelchairs and walkers.

Part D – Prescription drug coverage

Medicare Supplement Insurance (Medigap) – Covers some of Medicare’s cost-sharing requirements and services not covered by Medicare.

Why you should take advantage of this enrollment period:

• Possibility of upgrading or downgrading plans (Medicare Advantage versus Original)
• Opportunity to reevaluate or change Part D
• Peace of mind knowing that you do not have to rely on COBRA or job security in order to be covered by insurance.

Good to know:

• The general enrollment period for Medicare is between January 1^st and March 31^st
• During the general enrollment period, coverage kicks in one month post-enrollment.
• You can apply for Medicare even if you are already covered elsewhere.
  
  

If you missed our May 16 webinar, "The Naked Truth Behind Insurance Cards," replay resources are now available. Product experts Cheryl Field and Kimberly Sturm join forces to relay best practices that keep your reimbursement on track, despite variations in payers and managed care contracts.

Download the webinar replay or slides  - or join us for another upcoming event.

Join Cheryl Field and Kimberly Sturm for our May 16 webinar (12:30 p.m. ET): The Naked Truth Behind Insurance Cards. They'll discuss key practices that help keep managed care aligned with the contract and your revenue on track:

• Eligibilty details behind the insurance card 
• Knowledge of payer contracts and benefits
• Strategic actions for payer communication
• Tips to avoid "taking a bath" (so you won't be left "naked" during reimbursement)

After, you'll hear how Managed Care MASTER and primeCLAIMS simplify these processes even further.

Is it HETS or miss?

In a recent issue of CMS’s Medicare Learning Network Matters News Flash, SE 1249, CMS reaffirmed its intention to replace the Common Working File (CWF) Medicare beneficiary health insurance eligibility queries with HIPAA Eligibility Transaction System (HETS). (You can refer to last year’s blog posting for more details.) However, CMS has opted to postpone (again) the CWF access termination – this time indefinitely, but with a caveat. While this announcement will not affect the use of DDE to submit claims or to correct claims and will not impact access to beneficiary eligibility information, providers “should immediately begin transitioning to the Medicare Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS).”

Succinctly put, “While termination was originally scheduled for April 2014, CMS is delaying the date. CMS will provide at least 90 days advanced notice of the new termination date.”

So, in other words, transition to HETS sooner than later or you are at risk of missing out. Borrowing from our earlier blog, at some point in time you will no longer be able to check on a resident’s Medicare eligibility through the Common Working File (CWF).  HETS is replacing CWF inquiries. In a way, CMS has made life much easier for billers, because with HETS you can check a beneficiary’s eligibility in real time. CMS has simplified the eligibility checking process so that through HETS you can submit your inquiry with a real-time 270 request and receive your 271 response, a Functional Acknowledgement (999), an Interchange Acknowledgement (TA1), or a proprietary error response over a secure connection. According to the guide, “The information included in the 271 response is not intended to provide a complete representation of all benefits, but rather to address the status of eligibility (active or inactive) and patient financial responsibility for Medicare Part A and Part B.” This change will likely require you to change your billing processes.

Some of the information HETS will reveal to you will be in a format somewhat different from what you may be used to. Also, HETS will eventually be able to send Hospice information in the same format as the CWF. The HETS 270/271 Companion Guide gives you more insight into the eligibility information you will receive in the HETS 271 response.

ProClaim Partners offers direct access to HETS through its enterprise-class automated claims clearinghouse portal. Not only can you submit, monitor, and correct claims, if necessary, you can also determine a Medicare beneficiary’s eligibility. You can select exactly what information you want to see. There is no need to bounce between applications; your information regarding all things Medicare and other insurance payers is conveniently accessible in your own branded portal.

Question: If you are using HETS, how has this changed how you check a resident’s eligibility?