New Realities: The Section 111 Connection to Conditional Payments and Claim Outcomes

Section 111 reporting historically has been viewed as an abstract technical Medicare compliance obligation and the responsibility of an IT department, because it involves the electronic transmission of data to Medicare. In the last year and a half, however, the situation has changed. What’s Changed Now, the Commercial Repayment Center’s (CRC) recovery for conditional payments […]

Risky Business: Five Essential Tips for Section 111 Reporting

Your Section 111 reporting program may seem clear-cut, but it can mean risky business if your team isn’t prepared to avoid the pitfalls of common compliance mistakes. The primary objective of Section 111 reporting is to alert Medicare to bodily injury claims involving Medicare beneficiaries. This sets the course for Medicare to track claim-related payments […]

CMS Releases Updated Reporting and Recovery Thresholds with News on TPOCs

The Centers for Medicare and Medicaid Services (CMS) has released its latest alert regarding its low-dollar reporting and recovery thresholds pertaining to liability (including self-insurance), workers’ compensation, and no-fault settlements, judgments, awards, or other payments (settlements). CMS’s December 12, 2016, alert, Change in Reporting Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, […]

Should You Purchase MSA Liability Insurance?

It’s estimated that the number of Medicare beneficiaries will reach 80 million by 2030. When it comes to Medicare Secondary Payer (MSP) compliance, enforcement will likely increase as the number of beneficiaries grows and Medicare’s budget becomes pinched. Insurers need to start planning now for the increased compliance burdens they may face. So, should you […]

Deep Dive: Clinical Trials and Section 111 Reporting

ISO Claims Partners is dedicated to demystifying Section 111. Today I’d like to take a deep dive into one reporting trigger of Ongoing Responsibility for Medicals (ORM) by exploring clinical trials. Created by CMS specifically for Section 111 reporting, ORM is the responsibility “presently assumed” to pay for medical treatment related to an accident or […]

Preparing for ICD-10: Are You Ready?

For the past year, it’s been difficult to overlook the numerous reminders from the Centers for Medicare and Medicaid Services (CMS) regarding the upcoming transition from ICD-9 to ICD-10. The change is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA) and plays a critical role for our clients in the area […]