• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Protecting and Enhancing Revenue for Hospitals

Healthcare Revenue Cycle Management

  • Services
    • Reimbursement Services
    • Revenue Integrity
  • Insights
  • Blog
  • About
    • Core Values
    • Management Team
    • News
    • Careers
      • Current Openings
  • Contact
  • 877.4BESLER info@besler.com
  • Search
Feb 24

How the transition from the Common Working File to HETS could affect revenue at your hospital [PODCAST]

Blog, Revenue Cycle, The Hospital Finance Podcast® Michael Passanante

Hospital_Finance_Podcast smallIn this episode, Jon Besler, BESLER Consulting’s President & CEO, explains what the HIPAA Eligibility Transaction System (HETS) is, why it’s replacing the Common Working File (CWF), and the unintended consequences that could cost your hospital revenue.

https://media.blubrry.com/readmissions/p/content.blubrry.com/readmissions/HFP002_-_HETS.mp3

Podcast (hfppodcast): Play in new window | Download

Subscribe Stitcher | RSS | More

HETS is essentially Medicare’s replacement for the CWF as it moves towards deploying a HIPAA compliant database.

Jon notes that one of the most significant changes regarding this transition is that retrospective access to claims data through HETS is proposed to be 12 months. Currently, in the CWF, providers can look back four years to make claim adjustments.

Impacts of this change include:

  • The inability of providers to review claims previously audited by RACs
  • Limiting retrospective Transfer DRG billing adjustments
  • Inability to verify the status and start date of beneficiaries’ eligibility relative to claims used to calculate penalties for the Hospital Readmissions Reduction Program (HRRP) or the Hospital-Acquired Condition Program (HACRP).

Any hospital using the Common Working File for claims review will be affected by the change to HETS.

CMS has not yet set a mandatory date for transition to HETS. However, CMS has said that upon a 90-day notice to the provider community, they can eliminate access to the Common Working File and fully implement the HETS system. At this time, no announcement has been made.

Hospitals may not be aware of this issue because CMS published this information through a very informal process called a release summary. These summaries are essentially outside of the traditional rule-making process which would allow providers to comment and discuss proposed changes with CMS.

While the movement towards a more HIPAA-compliant system is a favorable development, the proposed look back period for hospitals is concerning.

BESLER Consulting has worked with the New Jersey state hospital association other state hospital associations to help shepherd a meeting with CMS to make them aware of the concerns around the look back period and some of the unintended consequences accompanied by this proposed change.

Resources related to this episode:

 

  • Update regarding HIPAA Eligibility Transaction System (HETS)
  • HIPAA Eligibility Transaction System help from CMS
Michael Passanante's avatar

About Michael Passanante

Michael Passanante is Vice President of Strategic Growth at BESLER.

sidebar

Blog Sidebar

Click here to follow our blog. Get the latest news and resources related to hospital reimbursement delivered to your inbox weekly.

Categories

  • Blog
  • Bundled Payments
  • Case Study
  • Compliance
  • Cost Report
  • Covid-19
  • DRG
  • HFMA Peer Review
  • IME
  • Infographic
  • News
  • Readmissions
  • Reimbursement
  • Revenue Cycle
  • Revenue Integrity
  • Special Report
  • The Hospital Finance Podcast®
  • Transfer DRG
  • Uncompensated Care
  • Webinar
  • White Paper

Subscribe to Podcast

Apple PodcastsGoogle PodcastsSpotifyAndroidRSS

Footer

Besler

Let’s Connect

609.514.1400 | 877.4BESLER
116 Village Blvd., Suite 200
Princeton, New Jersey 08540

BESLER’s Services

  • Reimbursement Services
    • Medicare Cost Report Reviews & Prep
    • DSH Reviews
    • S-10 Review
  • Revenue Integrity Services
    • Inpatient DRG Validation
    • Transfer DRG
    • IME Revenue Recovery

Follow our blog

Get weekly Medicare reimbursement insights

©2022 BESLER. BESLER is a service mark of Besler & Co., Inc. d/b/a BESLER | info@besler.com
Terms of Use / Privacy Policy / Website by Web Savvy Marketing
*HFMA staff and volunteers determined that Revenue Integrity Solutions including Transfer DRG Revenue Recovery Service, Inpatient DRG Validation and IME Revenue Recovery and Easy Work Papers have met certain criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this service.