CMS Updates Go into Effect

By Carlos Martins November 6, 2013

Carlos MartinISO ClaimSearch® Medicare Secondary Payer Reporting Service helps insurers comply with CMS regulations. Customers who participate should be aware that CMS has recently implemented changes that affect reporting.

TPOC THRESHOLD REDUCED
For TPOCs dated on or after October 1, 2013, the reporting threshold for liability and workers' compensation has been reduced to $2,000 (from $5,000). The primary effect of this change is that you will likely see more reportable claims. Please modify your processes to submit all TPOCs above $2000. The minimum threshold remains at $300; CMS will reject all TPOCs below $300.

CAUSE OF INJURY and NON-MEDICARE BENEFICIARY RECOMMENDATIONS
CMS recently amended its guidelines, making the Cause of Injury code (“E-Code”) and identification of the payee in the event of death of the claimant (non-Medicare beneficiary) optional. ISO ClaimSearch will continue to accept this optional information and report it to CMS. To help our members avoid unnecessary CMS rejections for optional fields, this information will be validated by ISO ClaimSearch and will be reported to CMS only if the information reported in these fields is valid.

ICD-10 PREPARATION
Effective October 1, 2014, CMS will accept ICD-10 diagnosis codes, replacing the current ICD-9 codes used for Section 111 reporting. Because these codes are supplied by the provider community, if you enter claims via the ISO ClaimSearch website, your changes should be minimal. For example, you'll be able to enter ICD-10 codes received or looked up through the ISO ClaimSearch look-up tool or spreadsheets of valid codes. If you enter claims through system-to-system reporting, your claims systems must be capable of recording and forwarding ICD-10 codes.

ISO ClaimSearch will open the test environment on November 11, 2013, for customers ready to test their implemented changes at that time.

Changes will include:

  • the addition of the new ICD-10 diagnosis and Cause of Injury codes on the ISO ClaimSearch website and in the record layouts for system-to-system companies
  • an updated look-up table and spreadsheet to include ICD-10 codes in addition to the current ICD-9 capability
  • new warning messages to alert you when you’ve entered an invalid code. (Diagnosis coding for claims with a date of incident before April 1, 2015, can continue to use ICD-9 codes indefinitely.)

CMS has announced a six-month grace period, beginning October 1, 2014, before the ICD-10 requirement will be enforced, and ISO ClaimSearch will incorporate this rule as well.

We’ll continue to monitor these changes and provide additional details as the 2014 implementation date approaches. For more information, please contact ISO Customer Support at 1-800-888-4476 or ClaimSearchMSP@iso.com.

Get started with ISO ClaimSearch Medicare Secondary Payer Reporting Service.


Carlos Martins

Carlos Martins, SCLA is Vice President and General Manager of ISO ClaimSearch Solutions. Carlos leads the operations of ISO ClaimSearch®, the property/casualty industry’s premier and only “all claims” database with over 1.2 billion claim records and market participation of more than 90 percent of the property/casualty insurance industry. Carlos is also responsible for the surrounding ecosystem of integrated solutions for ISO ClaimSearch which includes claim scoring, predictive analytics, third-party data, and visualization tools. Carlos brings to this role – and all ISO ClaimSearch participants – more than 30 years of experience in the property/casualty industry, where he has held a wide range of claims and technology roles. He is based in Jersey City, New Jersey and can be reached via email cmartins@iso.com or 201-469-3103.