Responsible Reporting Entity (RRE)
Think about your thresholds: Preventing errors to avoid CMS penalties
One way responsible reporting entities can attempt to achieve full CMS compliance and avoid potential penalties is to closely consider file thresholds.
Big reforms are coming to Michigan PIP - How the changes will impact Medicare Secondary Payer compliance
On 5/30/19, Governor Gretchen Whitmer signed Michigan Senate Bill 1, which makes significant changes to Michigan’s personal injury protection (PIP) system.
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…
To avoid CMS penalty exposure time is of the essence
The timely reporting of ORM and TPOC data to CMS is of key importance to insurers, especially now enforcement of noncompliance penalties is on the horizon.
Medicare watch list: Staying ahead of the Medicare Secondary Payer compliance curve
As another new year settles in, we know at least one thing is certain: MSP compliance will continue to present formidable challenges for claims payers.
CMS Releases New Section 111 NGHP User Guide (Version 5.3)
The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 non-group health plan (NGHP) User Guide (Version 5.3, December 15, 2017).
Medicare Section 111 process change eases one compliance burden
RREs will no longer automatically be moved into “discontinued” status if they fail to provide Medicare the requested annual recertification information.
Deep dive: Clinical trials and Section 111 reporting
When it comes to clinical trials, there are a range of possibilities. Although CMS generally doesn’t consider ORM likely in liability claims, it exists in certain…
Medicare conditional payment compliance: Myth vs. fact
The statutes and regulations that govern Medicare have been referred to by courts as “the most completely impenetrable texts within human experience.” With the complex…
Using the Section 111 query process to your benefit
Responsible reporting entities (RREs) are required first to identify Medicare beneficiaries and then report certain data to Medicare in the form and manner specified by…
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…
CMS releases new Section 111 alert regarding SSNs
CMS has released a new NGHP Section 111 alert providing additional information regarding its plans to allow RREs to submit partial social security numbers (SSNs) for…
CMS alert: Introducing recovery agents
The Centers for Medicare and Medicaid Services (CMS) has released a technical alert outlining the role of a designated recovery agent in Medicare Secondary Payer (MSP)…