Medicare Secondary Payer Section 111 Reporting – Top 10 Issues for Companies and Agents.

Slides:

Advertisements

Similar presentations

MEDICAID & SCHIP EXTENSION ACT OF 2007 (MMSEA). HISTORY OF MSP Old Statute – New Teeth Medicare first enacted – Medicare was the primary payer.

Advertisements

NJAIRE Claim Determination Form Training. Purpose of training Reinforce expectations of member company claim reporting Identify common errors made in.

WELCOME TO THE INDUSTRIAL COMMISSION SELF-INSURANCE SEMINAR.

©2011 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Georgia Medicaid Fair Crossovers Presentation.

UPDATE ON MEDICARE’S REPORTING REQUIREMENTS SC Self-Insurers Association, Inc. General Membership Meeting November 4, 2010 Daniel W. Hayes, Esquire.

1 Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs) Centers for Medicare & Medicaid Services As of 9/16/05.

Remittance Advices (RAs) will now be in a PDF format, referred to as WebRAs. Providers will be automatically switched from paper RAs to WebRAs. Providers.

Franco Signor Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 Bennett L. Pugh Franco Signor 1618 Montgomery Hwy. Suite 104 #278 (205)

RFC ADMINISTRATORS, INC

Medicare Compliance Overview Jessica C. Smythe, Esq. Crowe Paradis Services Corporation Dave Peterson, Esq. Jones Funderburg Sessums Peterson & Lee, PLLC.

CMS is Coming! CMS is Coming!…Are You Ready?. Introduction So you think you are ready for an audit…maybe, maybe not. This presentation will discuss some.

© 2009 Smith Moore Leatherwood LLP. ALL RIGHTS RESERVED. Section Are You Ready for the New CMS Reporting Requirements? Presented by: Erin S. Zuiker.

PRESENTED BY: Tim Doherty SRS – Specialty Risk Services PO Box 5340 Manchester, New Hampshire (603) Elizabeth Hurley, Esq. GETMAN,SCHULTHESS.

Top 10 Medicare Compliance Myths Presented By: Charles G. Brown, Esq. Chair, Medicare Compliance Group Bridget Langer Smith, Esq., MSCC Vice Chair, Medicare.

Medicare Secondary Payer Compliance for US Property & Casualty Insurance 24 May 2011.

Achieving Compliance: Taking Medicaid & Medicare’s Interests Into Account Florida State Association of Rehabilitation Nurses 36th Annual Educational Conference.

Surviving MMSEA Section 111 June 30, 2009.

Medicare Secondary Payer and Negligence Lawsuits an Overview Patricia J. Foltz Anderson, Rasor & Partners, LLP June 21, 2013.

Translating CMS Terminology for your Claims Department And How to translate your children’s text messages. VISIONS FOR THE FUTURE.

Government of the District of Columbia Department of Health Care Finance ‹#› For Government Use Only 1 Pregnant Women Presumptive Eligibility Division.

Solutions to New Medicare Compliance Rules: A Presentation to the National Council of Self-Insurers National Coverage.

Additional Safeguards Session Law Recoupment/Repayment Plan Personal Care Services State Plan Amendment July 2, 2014.

Self-Select Voluntary Separation Program (SSVSP) 1.

WebEx Training Friday, January 31 st Agenda Clarification on Employer Coverage Disenrollment/Reimbursement In-House Patients providing Documentation.

11 Workers’ Compensation and Injury Management Long Duration Claims and Delays in Return to Work 31 October 2013 Chris White A/Chief Executive Officer,

Insurance Handbook for the Medical Office

2010 Medical Professional Liability Symposium Chicago, IL ~ March 18 & 19, 2010 MMSEA Section 111 Reporting: The Elephant in the Room?

Medicare, Medicaid, and SCHIP Extension Act of 2007 and the Medicare Secondary Payer Act (MSP) LMSA: The Train at the End of the Tunnel.

Medicare’s Interest in Workers’ Compensation Cases

Lucy Hester Sellers Attorney at Law ARMS and CMS Reporting Requirements Refresher ACSBA Conference June 22, 2013 Lucy Hester Sellers, JD

MARCH 2009 Current Approach Options for MMSEA Reporting & Other Compliance Issues (MSAs) PRESENTOR John V. D’Alusio EVP, Senior Claims Officer Avizent.

Understanding the Exposure SCHIP Mandatory Insurer Reporting & MSP Compliance.

MEDICARE MANDATORY REPORTING: Keeping Your Company in Compliance with the Medicare, Medicaid and SCHIP Act Mandatory Reporting Requirements McAnany, Van.

1 NY Chapter - RIMS MMSEA Reporting & MSP Compliance.

MEDICARE SECONDARY PAYER ACT Mandatory Reporting Requirements.

Medicare Set Asides… …the untold story SC WC Educational Conference March 1, 2010.

Self-Insurance Quarterly Workshop Dave Sievert – Interim Director, Self Insured Department.

Beating Workers’ Compensation Fraud With Technology NCSI 2009 Annual Meeting May 18,

Therapy Cap: Exceptions January 1 - October 1, 2012 : an automatic exception to the therapy cap may be made when documentation supports the medical necessity.

Claims Compliance Analysis Amy Kanter, SBS Auditor Michigan Department of Health and Human Services 2015 SBS Conference – Traverse City, MI August 17 &

Wyoming Medicaid Provider Web Portal Wyoming Medicaid Provider Workshops Summer 2015 Presenter: Kilee Thompson, Field Representative.

1 Medicare Compliance in Workers’ Compensation and Liability Cases: Conditional Payment Claims, Mandatory Reporting and Medicare Set-asides Joe Isbell.

Medicare & Workers’ Compensation

HP Provider Relations October 2011 CMS-1500 – Medicare Crossover Claim Billing.

Welcome ! Residual Market Audit Services NJ AIRE Compliance Audit Program Jack O’Keefe.

Katie A. Fox, MSCC September, 2009 Medicare Secondary Payer Today & Tomorrow.

Overview Creating a Bill and Billing Manual. Objectives Review the Credentialing Process Setting up the Practice Management Systems Items to Consider.

Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) Overview Carolina RIMS September 2009.

1 Beware MMSEA: Are You in Compliance? Bennett L. Pugh Carr, Allison, Pugh, Howard, Oliver, & Sisson 100 Vestavia Parkway Birmingham, Alabama (205)

New Mandatory Medicare Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid & SCHIP Extension Act (MMSEA) An Insurer Perspective.

Presented by: Russell S. Whittle, Esq., MSCC, CMSP Taking Medicare’s Interests Into Consideration: Mandatory Insurer Reporting (MIR)

RESEARCH AND RESOLVE Professional Claim Denials HP Provider Relations/June 2014.

Medicare Secondary Payer Act: CMS Recovery from Ace Michael J. Ruggiero King & Spalding LLP

Medicare Secondary Payer – Process and Best Practices October 21, 2009 Roy A. Franco, Safeway Inc./ Medicare Advocacy Recovery Coalition.

Medical Manager Unit 6 ICBS 170. Medical Manager  Billing Routines Generation of bills and statements sent to guarantors and insurance companies Patient.

2011 OGS State Purchasing Forum Navigating Proof of Coverage May 18-19, 2011 Required Proof of NYS Workers' Compensation and Disability Benefits Insurance.

Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) November 10, 2015.

Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. Timely Filing and Corrected Claims October.

PROTECTING MEDICARE’S INTERESTS IN LIABILITY SETTLEMENTS Presented by: Todd A. Kipnes.

Medicare & Workers’ Compensation Jonella Windell Centers for Medicare & Medicaid Services (CMS)

Medicare Secondary Payer Compliance Services Welcome to Allsup’s Mandatory Insurer Reporting Services website.

Cliff Connor, Vice President of Medicare Compliance, Gallagher Bassett Roy Franco, Chief Client Officer, Franco Signor Barry Dillard, Director, Claims.

Next Steps for Lloyd’s Market GL-Service Users

Medicare Secondary Payer and Negligence Lawsuits an Overview Patricia J. Foltz Anderson, Rasor & Partners, LLP January 24, 2014.

Medicare, Medicaid, and SCHIP Extension Act of 2007

GENEX Services, Inc. Presentation of

Welcome! Residual Market Audit Services NJ AIRE

Benefits Coordination

Unraveling The MMSEA Sec. 111 Reporting Requirements

Welcome! Residual Market Audit Services NJ AIRE

Presentation transcript:

Medicare Secondary Payer Section 111 Reporting – Top 10 Issues for Companies and Agents

2 Medicare Secondary Payer – Section 111 Issues in Medicare Secondary Payer Reporting John Giknis, CPCU, SCLA, RPA, AIC Assistant Vice President ISO ClaimSearch Operations

3 Medicare Secondary Payer – Section 111 Requirements The Medicare Secondary Payer legislation, section 111, requires insurers and self insurers (Responsible Reporting Entities) to report all claims involving Medicare- eligible claimants to the Center for Medicare and Medicaid Services (CMS). Companies must register as an RRE with CMS prior to reporting. Lines of business include Workers Comp, Liability and No-Fault claims, considered “Non-Group Health Plan” (NGHP). Quarterly reporting involves all Medicare-eligible claimants – Recurring payments (WC and no-fault): report at first payment or acceptance of coverage and at end of “ongoing payment responsibility” (ORM) – Single payment liability claims: report only at settlement, judgment or award by Total Payment Obligation to the Claimant (TPOC) date

4 1.The RRE Determination – Who/What is the RRE? Insurer Self Insurer Self-insured Pool – How many RRE’s are needed? 2.The CMS Registration Process – Group vs. Affiliates and Subsidiaries – TIN and Entity Name must be compatible – Selection of Agent – or direct reporting – Account Manager selection “Invite” account designees Medicare Secondary Payer – Section 111 Issues

5 3.How to determine if the claimant is a Medicare recipient (beneficiary) – Claimant is 65 or over – Claimant is under 65, but qualifies for Medicare – Use the CMS Query 4.Complication from CMS Reporting Requirements – IT resources – Availability of data: SSN/DOB – Training staff on unfamiliar reporting elements – Obtaining information from archived files – Issues “under consideration” – Reporting periods – Thresholds Medicare Secondary Payer – Section 111 Issues

6 5.Determining Reporting Types – Ongoing Responsibility for Medicals (ORM) – Total Payment Obliga tion to Claimant (TPOC) 6.Quarterly Reporting – Reporting period (per RRE) – Separate file for acknowledgments/ rejections – Return results to company claims systems 7.Query Process – Same RRE issues – One file per RRE per month – Which claims (claimants ) to query – When to stop querying – Required fields: how to identify in history files Medicare Secondary Payer – Section 111 Issues

7 8.Rejections – Rejection file per RRE – How to identify prior to submission to CMS – How to correct and return – timing 9.CMS Communications/Direction – Changes in requirements, thresholds and timing – Issues “taken under advisement” 10. Indemnification Issues Medicare Secondary Payer – Section 111 Issues

8 Medicare Secondary Payer – Section 111 Additional information on the ISO ClaimSearch Medicare Secondary Payer, Section 111 service – For more information or requests, please – Overview and training documents available on the ISO CMS website: