decisionhealth Newsletters, Part B News - 2026 Issue 4 (April)
Protect revenue, ensure patient eligibility access update in HETS
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Article Overview
This article explains a CMS update to patient eligibility checking through HETS and why it matters for practices that rely on vendors or other third parties. It focuses on the operational impact for billing, revenue cycle, and practice management teams, including the need to confirm vendor relationships, obtain required enrollment information, and review CMS guidance and rules of behavior.
Why This Topic Matters
Practices that depend on outside vendors for eligibility checks may face disruptions to coverage verification and payment processing if they do not complete the required HETS-related steps. The article is relevant to organizations that manage claims-adjacent workflow, compliance, and vendor coordination.
Article Sections
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Practice management
Introduces the CMS change and the operational context for practices that depend on outside vendors for eligibility verification.
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No attestation, no payments
Discusses the impact of the HETS update on coverage verification workflow, vendor enrollment, and payment continuity.
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Work with vendors, don’t blame them
Describes provider and vendor coordination challenges, including concerns from revenue cycle and practice management stakeholders.
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Act now to prevent an eligibility blackout
Summarizes CMS guidance, implementation timing, and the general steps practices are expected to review for HETS access.
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Resources
Lists external CMS reference materials related to HETS enrollment and rules of behavior.
What You Will Learn
- How a CMS HETS update affects patient eligibility checking workflows
- Why vendor coordination matters for practices that outsource eligibility verification
- What broad information practices need to review for HETS access and attestation
- Where CMS guidance and related reference materials are located
Who Should Read This
- Physician practices
- Revenue cycle management teams
- Billing companies
- Compliance officers
- Practice managers
- Facility-based provider organizations
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