HETS
HETS (HIPAA Eligibility Transaction System) is the system the Centers for Medicare & Medicaid Services (CMS) uses to answer real-time Medicare eligibility inquiries from providers. Home health agencies query HETS, usually through their EHR, a clearinghouse, or a Medicare Administrative Contractor portal, to confirm a patient's Medicare Part A and B status, Medicare Advantage enrollment, hospice election periods, and other coverage details before admitting and billing.
Definition
HETS (HIPAA Eligibility Transaction System) is the system the Centers for Medicare & Medicaid Services (CMS) uses to answer real-time Medicare eligibility inquiries from providers. Home health agencies query HETS, usually through their EHR, a clearinghouse, or a Medicare Administrative Contractor portal, to confirm a patient's Medicare Part A and B status, Medicare Advantage enrollment, hospice election periods, and other coverage details before admitting and billing.
Why it matters
HETS is part of the Compliance & Survey vocabulary used across home health operations, documentation, and revenue cycle. Understanding it helps clinicians, QA leads, and administrators stay aligned on care quality and compliance.
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