Category Archives: Medicare Reporting Section 111

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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CMS Issues Alert on ICD-9 and ICD-10 Exclusions

25 May 2016 Heather Sanderson No Comments

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News

The Centers for Medicare and Medicaid Services (CMS) released a technical alert dated May 23, 2016 related to Non-Group Health Plan (NGHP) MMSEA Section 111 reporting. This alert communicates that there are newly excluded ICD diagnosis codes that will no longer be accepted by CMS beginning on January 7, 2017.  The exclusion includes codes from both the ICD-9 and ICD-10 revisions as follows:  ·         ICD-9-CM o   999.9 (Other …
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Blog, Franco Signor News, Medicare Reporting Section 111

SARASOTA/BRADENTON, FL (PRWEB) APRIL 08, 2016 Two of the workers’ compensation industry’s most innovative companies have joined forces to provide a premium client experience for Medicare, Medicaid, and SCHIP Extension Act (MMSEA) reporting services. Both Franco Signor and Tropics Software Technologies have lengthy histories serving the workers’ compensation industry. By combining their years of experience and knowledge, they plan to …
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Commercial Repayment Center Issuing Demands on WC/NF Claims

14 Mar 2016 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Reporting Section 111, Medicare Secondary Payer News

The Commercial Repayment Center (CRC) took over a portion of the non-group health plan conditional payment recoveries on October 1, 2015. The CRC is charged with recoveries where the identified debtor is the insurance carrier and CMS has been notified via Section 111 reporting of a primary payer. The Benefits Coordination and Recovery Contractor (BCRC) continues to pursue recoveries where …
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An Administratively Closed Claim Does Not Equal ORM Termination

15 Feb 2016 Heather Sanderson No Comments

Blog, Medicare Reporting Section 111, ORM, RRE

In reviewing numerous reporting programs we have found that there is confusion within the industry regarding the proper indicators in which an RRE can terminate Ongoing Responsibility for Medical (ORM) for Section 111 MMSEA reporting. ORM occurs where an RRE has undertaken the legal responsibility to pay for a claimant’s medical treatment or where an RRE is required to pay …
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