Transitioning to HETS: Is Your Agency Next?

For years, Medicare has cautioned providers that access to the Common Working File (CWF) would eventually be phased out in favor of a new online platform known as the HIPAA Eligibility Transaction System (HETS). While the transition aims to modernize and streamline data access, the process has been delayed, largely due to challenges with hospice-specific data.

For many providers, HETS offers accurate and timely eligibility details. However, for hospice agencies, critical information such as historical hospice elections and prior billing dates is often incomplete or entirely missing from the HETS system. 

The Hospice Gap: Why CWF Still Matters

Hospice providers rely on the CWF to view detailed and historical information regarding patients’ hospice benefit usage, including prior agencies, benefit periods and revocations. Without this data, it becomes difficult to make informed decisions about patient eligibility and billing. 

For example, not knowing if a patient has exhausted their benefit periods or recently transferred from another agency can delay care or result in billing complications. The gap in HETS functionality is likely a key reason Medicare has not finalized a cutoff date for CWF access. 

Early Restrictions Are Already Taking Effect

Although a full transition hasn’t occurred, some newer hospice agencies are already feeling the effects. Providers who never had access to the CWF are now limited to HETS-only systems through clearinghouses or EMR platforms. As a result, billing teams—like ours at Advanced Revenue Cycle Management—face significant roadblocks when trying to verify eligibility or research past claims.

We urge CMS to delay the full implementation of HETS for hospice providers until the system offers a complete view of patient history. Accurate data access is essential for effective revenue cycle management, and we’re committed to keeping our clients informed every step of the way. Please contact us with any questions you might have about this transition or anything regarding your account.