ICD-10 Codes
CMS releases new NGHP Section 111 User Guide (Version 6.0) and updated accepted/excluded ICD code listings
On 10/5/20, CMS released an updated Section 111 NGHP User Guide, V. 6.0. They also released updated versions of accepted and excluded ICD-9 and ICD-10 codes for 2021.
CMS holds Section 111 NGHP update webinar
On 8/13, CMS held a webinar on Section 111 non-group health plan reporting. The webinar covered NGHP Section 111 reporting best practices and MSPRP enhancements.
Insurance fraud detection in action: Identifying suspicious medical billing during the COVID-19 crisis
Taking a closer look at medical billing helps identify pandemic-related issues that can put patients at risk and negatively impact insurers’ bottom lines.
Medicare enables COVID-19 ICD-10 code for Section 111 reporting
The CDC issued a bulletin advising it is implementing the new ICD-10 U07.1 for “COVID-19, virus identified” in an off-cycle update effective 4/1/20, to code the COVID-19…
CMS releases new NGHP Section 111 user guide (Version 5.7)
On 10/7/19, CMS released an updated Section 111 User Guide (Version 5.7) regarding non-group health plans (liability, no-fault and workers’ compensation).
Conditional payment updates | Open Debt Reports are back; Pre-PCN worksheets are on hold; and CRC will continue to review all CPL disputes
There has been a flurry of recent activity from the Centers for Medicare and Medicaid Services (CMS) and the Commercial Repayment Center (CRC) regarding processing of…
Avoiding penalty problems by ensuring data accuracy
With CMS (Centers for Medicare and Medicaid Services) penalties on the horizon, we’ve been exploring how RREs (Responsible Reporting Entities) can be proactive in…
New realities: The Section 111 connection to conditional payments and claim outcomes
Section 111 reporting used to be viewed as an abstract technical Medicare compliance obligation & IT's responsibility because of the data transmission.
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 common compliance mistakes.
New CMS claims payment process begins January 1, 2016
On December 24, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a reminder that its claims payment process for ongoing responsibility for medicals (ORM)…
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-10 update
One of the most important developments in Medicare Secondary Payer compliance for 2015 will be the transition from ICD-9 codes to ICD-10 codes on October 1, 2015. On that…
Preparing for the ICD-10 Transition
CMS released an alert in May 2014 announcing that the ICD-10 diagnosis codes reporting for Section 111 is postponed until October 1, 2015.