Category Archives: ORM

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 …

Blog, Legal/Legislative News, Medicare Conditional Payments, ORM

Yesterday, CMS held a webinar on the applicable plans newly created right of appeal that went into effect on April 28, 2015. Because of the Strengthening and Repaying Taxpayers (SMART) Act, CMS was required to develop regulations outlining how an applicable plan (workers’ compensation, liability, automobile insurance, no-fault insurance, including self- insurance law or plans) would exercise this right. As …

Blog, Medicare Conditional Payments, Medicare Reporting Section 111, ORM, Reimbursements

Baumann v. American Family Mutual Insurance Company- 2012- District Court for District of Colorado Facts: Plaintiff was struck by an underinsured motorist on February 5, 2010 and incurred over $200,000 in medical expenses.  Medicare was billed $101,202.98 of that expense and paid $19,523.40 in benefits.  Plaintiff, an insured under two separate automobile policies, issued by Defendant, sought reimbursement for her …

Medicare Reporting Section 111, ORM, WCMSA

Katie A. Fox, MSCC – October 21, 2011 The much awaited Version 3.2 of the User Guide was released on August, 17, 2011. The User Guide outlines several changes, but hidden in section 11.8 is a process to manually terminate the ORM status between Section 111 claim detail electronic submissions.  Throughout the industry the subsequent memorandums have gained much publicity, …

Blog, Medicare Reporting Section 111, ORM, TPOC

By Katie A. Fox, MSCC Last Friday, the Centers for Medicare & Medicaid Services (CMS) issued an alert extending the mandatory reporting period for Liability cases with a Total Payment Obligation to Claimant (TPOC) only.  We wrote yesterday about the positive effect this would have on the liability industry struggling to get its data systems ready for reporting.   However, the alert also …


15 Nov 2010 Roy Franco No Comments

Blog, Medicare Reporting Section 111, ORM, RRE, TPOC

Franco Signor LLC – November 15, 2010 Centers for Medicare and Medicaid Services (CMS) issued new liability reporting rules in an alert on November 9, 2010. Click here for the Alert.  Responsible Reporting Entities (RRE) may now voluntarily report liability settlements, awards and judgments, without penalty, beginning next year. Mandatory liability reporting is now slated to start January 1, 2012, …

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