Hospitals' use of observation status harms Medicare beneficiaries as patients hospitalized for multiple days are denied coverage of subsequent care in a SNF. This is due to their time in the hospital being labeled outpatient, not inpatient. A Medicare beneficiary must spend three consecutive midnights in the hospital?not counting the day of discharge?as an admitted patient in order to qualify for subsequent nursing home coverage.
The Common Working File (CWF) has been replaced by the HIPAA Eligibility Transaction System, or HETS. If you currently use CWF queries to obtain Medicare health insurance eligibility information for Medicare patients, you should begin transitioning to HETS. CMS had to eliminate the CWF capability because it was not HIPAA compliant?ingoing and outgoing responses were not appropriately formatted to protect privacy. All information shared by covered entities for the purpose of sharing data for payment has to conform to the required HIPAA specifications. Unlike CWF, HETS will be available 24/7 and be HIPAA compliant.
Editor's note: This month's "Q&A" was modified from the HCPro book ICD-10 Essentials for Long-Term Care, written by Karen L. Fabrizio, RHIA, CPRA. ICD-10 Essentials for Long-Term Care provides you with a three-step plan that takes you from understanding the differences between ICD-9 and ICD-10 to full-scale ICD-10 readiness at your facility. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com. To submit a question for upcoming issues, email Managing Editor Olivia MacDonald at firstname.lastname@example.org.