Q: What types of beneficiary/eligibility data may be accessed from the provider Internet portal? What factors may affect the accessibility of certain types of beneficiary/eligibility data?
A: Once the user has entered the required beneficiary information and has submitted the Benefits/Eligibility query, the provider Internet portal may display the following submenu options:
Eligibility
Deductibles/Caps
Previous Inquiries
Preventive
MSP
Plan Coverage
Hospice/Home Health
Inpatient
However, the display and accessibility of specific Benefits/Eligibility tab submenu options (e.g., Hospice/Home Health, Medicare Secondary Payer (MSP), Plan Coverage) are contingent upon the availability of active data directly associated with the beneficiary and each submenu option.
Note: Once a specific beneficiarys information has been entered and submitted, only the submenu options that contain active data will display.
http://medicare.fcso.com/faqs/answers/256305.asp
Q: What information will appear on the SPOT, in the Deductibles/Caps section of Benefits/Eligibility, that pertains to the therapy cap and therapy thresholds?
A: The Centers for Medicare & Medicaid Services (CMS) HIPAA Eligibility Transaction System (HETS) is the source for all eligibility data accessed through the SPOT.
CMS made changes to HETS in 2013, which included changes to the types of eligibility data accessible under Deductibles/Caps.
Two subsections, Occupational Therapy Cap and Physical and Speech Therapy Cap, now display the used amount instead of remaining amount.
The used amount listed under each category will continue to increase even after the Cap has been reached to allow providers to determine when therapy usage has exceeded the cap and has reached therapy thresholds in accordance with Medicare policy.
Q: If the eligibility page on the SPOT displays the Inactive Period section, what does it mean? Has the beneficiarys Part A and/or Part B eligibility been terminated?
A: If the SPOT returns data in the Inactive Periods section, it means that although the beneficiary is entitled to Medicare, he or she is ineligible for Medicare benefits over a period of time for one or more of the following reasons:
The Medicare beneficiary has been classified as an illegal alien in the United States.
The Medicare beneficiary has been deported from the United States.
The Medicare beneficiary has been incarcerated.
Note: Information specifying the reason for the period of ineligibility will not be released by HIPAA Eligibility Transaction System (HETS), which is the source for all eligibility data accessed through the SPOT.
Note: If an inactive period is returned but a termination date for either Part A or Part B eligibility is not, it means that the Social Security Administration (SSA) still considers the beneficiary to be entitled to Medicare. However, during the specified inactive period, services furnished to that beneficiary will not be covered.
Q: If a beneficiary has a Medicare advantage (MA) plan, why would some or all of the information about the plan not be displayed in the Plan Coverage option under Benefits/Eligibility?
A: The Plan Coverage submenu option displays data regarding the beneficiarys enrollment — as applicable — in one or more of the following plans:
Medicare Advantage (MA)
Part D contracts
MA Managed Care Plans (i.e., Part C contracts) that provide Part A and B benefits for beneficiaries enrolled under a contract.
Note: If no active data is available, the Planned Coverage option will not be displayed.
However, the display and accessibility of information in Plan Coverage are contingent upon the availability of active data directly associated with the beneficiary. If the Centers for Medicare & Medicaid Services (CMS) has not been informed by the Social Security Administration (SSA) of the plan, the Planned Coverage option will not display.
It is the responsibility of the insurer to notify the SSA of the plan and of any information associated with the plan (e.g., policy number, name of insurer). Once the SSA has been notified, the information will be shared with CMS systems, including its HIPAA Eligibility Transaction System (HETS).
Since HETS is the source for all eligibility data accessed from the SPOT, the portal will display only data that is contained within the system.
Medicare secondary payer (MSP) FAQ
Q: If a beneficiary has coverage that is primary to Medicare, why would some or all of the information about the primary payer not be displayed in the MSP option under Benefits/Eligibility?
A: The MSP submenu option displays data regarding a beneficiarys coverage that is primary to Medicare. However, the SPOT will only display active MSP data of which the Centers for Medicare & Medicaid Services (CMS) has been notified. If no active data is available, the MSP option will not be displayed.
The display and accessibility of information in MSP are contingent upon the availability of active data directly associated with the beneficiary — as of the date of the query submitted. If CMS has not been informed by the Social Security Administration (SSA) of the coverage primary to Medicare (e.g., Medicare Secondary Working Aged Beneficiary, Spouse with Employer Group Health Plan), the MSP option will not display.
It is the responsibility of the insurer to notify the SSA of the coverage and of any information associated with the primary payer (e.g., type of primary insurance, policy number, name of insurer). Once the SSA has been notified, the information will be shared with CMS systems, including its HIPAA Eligibility Transaction System (HETS).
Since HETS is the source for all eligibility data accessed from the SPOT, the portal will display only data that is contained within the system.
Q: If I have to review the benefits/eligibility data for a beneficiary that I have already queried, will I need to enter his or her information in again?
A: No. If you need to review benefits/eligibility information for a beneficiary that you queried during the same session on The SPOT, click the Previous Inquiries submenu option — links to each beneficiarys data will display. Click the corresponding link, and you will have immediate access to available data for that beneficiary.
Q: Can multiple users be assigned to the same account for The SPOT? If an employee leaves an organization, can someone else in the organization use his or her User ID?
A: No. Each account has a unique User ID and Password, and each User ID is associated with a specific Social Security Number (SSN) and email address. Note: Only the last five digits of the individuals SSN will be visible to IACS and SPOT support staff.
According to CMS terms and conditions of use, account holders are not permitted to share their account passwords with anyone, including FCSOSpotHelp@FCSO.com. If the user shares his or her password, the security violation must be reported to CMS, and the account may be subject to suspension or removal.
If an organization requires multiple individuals to have access, each individual must register separately. If one of those individuals leaves the organization, the organization must notify FCSOSpotHelp@FCSO.com, so that the individuals account may be archived.
The reason for the aforementioned security requirements is to protect the providers proprietary information and to safeguard patients personal health information.
