CMS has reached out to all of their Trading Partners requesting that we remind our provider community of the “Rules of Behavior” when accessing Medicare Beneficiary eligibility data. As a reminder the authorized and unauthorized uses for accessing Medicare EV data were shared in June, see below.
CMS is concerned about the large increase in EV inquires they are seeing on or around the first of the month. They have asked us to remind our provider community that confirming a Medicare Beneficiary’s coverage or the beneficiary’s financial responsibility on the 1st of every month is not necessary for the following reasons:
- Medicare does not terminate at the end of the month.
- Beneficiary financial responsibilities do not change at the end of the month, it only changes at time of claim payment.
Please see the below message from CMS regarding eligibility requests.
“CMS requests that HETS Submitters work with these Medicare Providers/Suppliers to ensure that non-urgent eligibility requests are not submitted to HETS 270/271 during peak business hours (7:00 AM – 7:00 PM ET Monday – Friday). CMS reminds all Submitters that the database HETS 270/271 uses for Medicare beneficiary eligibility is updated once per day (in the overnight/early morning hours). There is no reason for a Medicare Provider/Supplier to resubmit the same eligibility request for a particular member multiple times per day. CMS also reminds all Submitters that they are responsible for ensuring compliance with the HETS 270/271 Rules of Behavior – those Rules can be found online here: https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/Downloads/EligibilityTransactionSystemInquiriesRulesofBehavior.pdf
CMS closely monitors all transactions to ensure compliance with the HETS Rules of Behavior. Your assistance in communicating this information to your internal staff and/or partners is appreciated.” If you violate any of these security requirements, you could lose systems access privileges and/or face disciplinary/adverse action up to and including legal prosecution. Federal, State, and/or local laws may provide criminal penalties for any person illegally accessing or using a Government-owned or -operated computer system”.
Our account managers are reaching out to clients that have been flagged by CMS as high submitters, but please feel free to contact your account manager, sales representative, or customer support with any questions about how this may apply to your account. We can work with you to adjust your EV submission rules if necessary.
