Providers in jurisdictions B and C were expecting shortages
of midnight oil at local stores this weekend. However, they have been given a
short reprieve. Reason being is that providers in those Jurisdictions that
submit claims electronically have been rapidly transitioning to submit claims
to CMS’s common electronic data interchange
(CEDI) so that they can meet the June 1 deadline. However, CMS has just
announced that the deadline will be moved to June 6, buying them a little more
time.
By next Friday, those providers must have adopted the new system in order to
have their claims processed by National Government Services
Inc. (NGS), the contractor that handles the CEDI front-end operations for
CMS.
Previously, each Medicare jurisdiction had its own protocol for electronic
claims submissions. The intent of the CEDI program is to create a single front
end for submitting claims electronically. With this change, providers will send
all electronic claims and claim status inquiry transactions to CEDI and CEDI
will return all electronic front-end reports directly to the submitter.
“Electronic trading partners” in Jurisdictions A and D have
already transitioned to CEDI on May 1, and, while the intent of standardization
makes a good deal of sense, so far, the reports haven’t exactly been
encouraging.
The issue of “volume” is the key sticking point for CEDI, according to Mark
Blount, vice president of marketing for HME billing and inventory software
provider Brightree Inc. In the move to
push the CEDI program through, Blount says the volume of electronic submissions
and the technology requirements that would entail were underestimated — to say
the least.
“Most folks are having to use dial-up modems to connect, and from what I am
hearing, 80 times out of 100 they are getting busy signals,” he explains,
adding that when providers do ultimately get through, their transactions might
get up to 90 percent of the way complete and then will drop off, forcing them
to endure the entire process again.
Another common problem providers submitting CEDI claims are experiencing are
password resets. The only way to address those resets is to call the CEDI help
line, which Blount says is overwhelmed with calls; and Blount has heard of
providers waiting as long as three hours on hold.
To combat the problem, Brightree has created a method to let its users submit
their claims in batches via FTP, so that they do not have to deal with CEDI’s
modem connections and the time-consuming headaches they entail.
“It’s another example of how the Internet is becoming a backbone in the way
providers do business,” Blount says. “Providers are all about providing great
customer care. They don’t want to deal with technology issues that keep them
from doing the things they wanted to do when they got into the HME business in
the first place.”
