Category Archives: Medicare Reporting Section 111

Blog, Medicare Reporting Section 111, ORM

In our oversight of numerous MMSEA Section 111 programs nationwide, we frequently answer many questions from clients surrounding Ongoing Responsibility for Medical (ORM). The confusion is understandable as ORM can be complicated. Let’s explore the various types of questions that we most often receive: What constitutes ORM? CMS defines ORM as a Responsible Reporting Entity (RRE)’s responsibility to pay for …
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Blog, Medicare Reporting Section 111, ORM, RRE, TPOC

We recently blogged regarding CMS releasing their updated NGHP User Guide version 5.3. The primary change outlined in the Summary of Changes in the User Guide was regarding CMS’ SSNRI initiative which will ultimately replace the use of SSN’s with MBIs. For more information, our prior blog can be found here. It appears that CMS has also modified another section of …
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CMS Releases Updated NGHP User Guide Version 5.3

27 Dec 2017 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News

CMS has released an updated Non-Group Health Plan (NGHP) User Guide version 5.3. It can be found here. The primary change to the User Guide involves detailing CMS’ transition with its Social Security Number Removal Initiative (SSNRI) and how this transition will impact MMSEA Section 111 Reporting. The SSNRI initiative mandates CMS to replace all SSN-based Medicare identifiers and distribute a …
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Blog, Medicare Conditional Payments, Medicare Secondary Payer News, TPOC

As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. Last year in 2016, CMS announced that the threshold would be $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance. The threshold means that if the …
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The Grinding Gears of CMS Regulation

27 Jun 2017 John Williams No Comments

Blog, Franco Signor News, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

The Grinding Gears of CMS Regulation A CLM Magazine Article by John Williams and Heather Sanderson Personal Injury and No-Fault Payers Should be Aware of Three Compliance Issues  As the Centers for Medicare and Medicaid Services (CMS) faces mounting pressure to address financial challenges, the agency is looking for methods to recover over-payments and ensure that it does not make a …
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Blog, Legal/Legislative News, Medicare Reporting Section 111

In a decision out of the Superior Court of Connecticut, Silver v. Miliford Medical Center Associates, 2017 Conn. Super. LEXIS 899 (May 11, 2017), a defendant medical provider filed a motion to compel the Plaintiff to respond to supplemental discovery so that its insurer could comply with the requisite requirements of MMSEA Section 111. Essentially, the medical provider’s insurer, which …
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Blog, Medicare Reporting Section 111

Today, CMS hosted a Town Hall regarding the SSN removal initiative (SSNRI) and its impact to Medicare Secondary Payer processes and particularly MMSEA Section 111 Reporting; For our prior blog on this Town Hall and the SSNRI, click here. There were two parts to the call: In the first segment, CMS explained its overall plan for SSNRI generally and how …
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NGHP User Guide Version 5.2 Released

11 Jan 2017 Heather Sanderson No Comments

Blog, Medicare Reporting Section 111, TPOC

CMS has released an updated Non-Group Health Plan (NGHP) User Guide version 5.2. It can be found here. There is only one minor change to the User Guide, which is to reflect the new thresholds for workers’ compensation, liability and no-fault claims which CMS had announced back in November. For our prior blog on the updated thresholds which were announced …
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Blog, Medicare Jurisdiction, Medicare Reporting Section 111

On the heels of CMS’ announcement from May 2016 that it was taking steps to comply with the Medicare Access and CHIP Reauthorization Act (MACRA), which requires CMS to remove SSNs from Medicare ID cards by April 16, 2019, CMS has announced an Open Door Forum call to address how this change would impact Section 111 processes. More information on …
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Blog, Legal/Legislative News, Medicare Reporting Section 111, TPOC

As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. For the past three (3) years, the liability TPOC threshold has been maintained at settlements of $1000 or less. CMS has announced via alert that the TPOC threshold for liability claims will remain …
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