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Tip of the week: How to use the common working file

Contemporary Long-Term Care Weekly, December 11, 2008

The common working file (CWF) is an important tool for long-term care billers.

The CWF contains vital information about your nursing home’s residents. Nearly everything a biller needs to know about a prospective resident is contained in the CWF. The CWF also houses a record of all Medicare claims processed for a resident. Knowing how to access and use the CWF is an important part of your job.

What is the CWF?

The CWF is the system that CMS uses to verify a resident’s entitlement to and correct use of Medicare benefits. When a person signs up for Medicare, the government establishes a record of him or her in the CWF. The CWF therefore contains each resident’s national Medicare record.

The CWF is a Medicare Part A and Part B benefit coordination and prepayment claims validation system that uses localized databases maintained by designated contractors called hosts, says Lee Heinbaugh, a consultant with PMG, LLC, in Cleveland. The purpose of the CWF is to perform prepayment edits and validation on fiscal intermediary (FI) and carrier claims. It also verifies beneficiary eligibility, she says.

What information is contained in the CWF?

The CWF is your skilled nursing facility’s (SNF) key to uncovering new residents’ Medicare eligibility. In addition to telling you whether a resident is covered by Medicare, the CWF contains information about whether he or she has elected a health maintenance organization (HMO), the date on which the resident became eligible for Medicare, and whether he or she elected hospice care.

The CWF lists effective dates for both Medicare Part A and Part B coverage, as well as termination dates. You’ll also find information about Medicare secondary payer situations, in which a resident has primary insurance that will pay for SNF services rather than Medicare. The CWF also provides the resident’s demographic information, including date of birth, date of death (if applicable), mammogram and Pap test frequency indicators, and other information used to determine the correct use of Medicare benefits.

How is the CWF used for screening residents?

The billing process actually starts during the preadmission process. Part of that screening includes a check of the CWF.

The CWF is where you can verify a prospective resident’s Medicare eligibility (see “Ten steps to verify Medicare eligibility” below). Before admitting a resident, an SNF’s admission team or billing staff must check the prospective resident’s coverage status. The screening includes whether the prospective Medicare resident

·  has any other insurance

·  has Medicare days left in the 100-day benefit or qualifies for a new 100-day benefit (due to a 60-day break in the so-called spell of illness)

·  is in an HMO or is receiving the Medicare hospice benefit

·  is being admitted to the facility within 30 days of a three-day qualifying hospital stay or another SNF stay

An SNF can check the CWF online to verify that the new admission has Medicare days available and qualifies for Medicare Part A or Part B. The facility must also screen the person for primary insurance coverage, (e.g., an employer-sponsored health plan), which would make Medicare a secondary payer, according to Karen Frazier Lusky, MSN, RN. For example, is the SNF stay due to a work-related accident? If so, workers’ compensation might be the primary payer.

The CWF also contains information about secondary insurance. Secondary insurance pays for care after Medicare ends. If the resident has secondary insurance, call the company to find out what it covers, advises Laura McDonnell, corporate business manager for Merrimack Health Group in Haverhill, MA.

Coinsurance is often paid by Medicaid or private insurance, which supplements Medicare on days 21–100, says McDonnell.

How do you access the CWF?

An SNF can check each resident’s CWF through Medicare’s online software, which an FI provides to facilities. Be sure that you acquire a copy of the software that your FI uses for Medicare, because it will allow your facility to access each resident’s CWF and transmit claims electronically, says McDonnell. The specific steps to access the CWF may vary depending on your FI.

If you are not sure of your facility’s FI, go to www.cms.hhs.gov/apps/contacts/incardir.asp for a list. Each FI is assigned to what is called a CWF host site. For example, the state of Indiana uses AdminaStar Federal as its FI, and its host site is Baltimore. The state of Kentucky also uses AdminaStar as its FI, but its CWF host site is Atlanta.

The CWF houses the records of all claims processed for all beneficiaries assigned to that site. Contact your FI for specific instructions and any applications you need to gain access to the CWF for your region.

What information do you need to access the CWF?

You need the resident’s name, correct Medicare number, and date of birth to access information from the CWF.

This is one reason why the accuracy of information obtained on admission is vitally important, McDonnell says. Dates of birth and Social Security numbers are frequently misread or copied incorrectly, so admission staff should take special care to obtain the correct information.

Are there issues with using the CWF?

Assessing information from the CWF sounds simple, right? However, the CWF can be tricky to use because it is not always accurate.

The CWF is only as good as the last bill submitted, says McDonnell. Therefore, the SNF should determine where each prospective resident has been since the last record in the CWF. For example, if a resident had previously stayed at a nursing home that did not bill in a timely manner, the CWF would not accurately reflect the resident’s number of Medicare days remaining.

“The CWF is an okay source, but not a great source” because of these flaws, says Heinbaugh. “It’s not a perfect system.” If a nursing home has a biller who does not submit claims on a timely basis, the CWF will not be up to date.

How can you use the CWF for online claims tracking?

When the FI receives a claim, it sends a query to the host CWF site to verify the Medicare Health Insurance Claim number and the name of the resident, as well as the appropriate utilization of the resident’s benefits.

Once processed by the FI, claims are sent to the CWF for additional editing and posting in the resident’s record. The CWF houses the records of all claims processed for all beneficiaries assigned to that host site. Any time that a claim processes, the CWF checks its records to verify the resident’s eligibility, days used, deductible and copayment status, and other utilization edits.

It’s important for billers to track Medicare claims carefully, says McDonnell.

Once claims are transmitted, they are usually available for viewing on the Web within 48 hours. So it’s a good practice to go online every two days and check their status, she says.

The FI will have a “claims corrections” area on the CWF, where claims that need correction will be placed pending resubmission.

The CWF is a great tool that billers can use to research claims, says Heinbaugh. You can see the reason an FI rejected a claim or why a claim has been delayed. You can also verify the status of a claim or find out when the FI will pay it.

It can also show you any pattern of billing errors, which your facility can then correct, says Heinbaugh. She often uses the CWF when performing a billing audit for an SNF.

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