Section 111 Reporting
Countdown to “full and final” settlements: Arizona S.B. 1332
The recent passage of Arizona Senate Bill (S.B.) 1332 provides Arizona claims payers with unprecedented opportunity to close out their workers' comp claims.
A solid second bite: CMS re-review now allows new medical documentation
Yesterday, CMS released a new Workers’ Compensation Medicare Set-Aside Portal User Guide that now allows for re-reviews of WCMSA decisions.
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.
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.
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…
The compliance gap: How you see your compliance vs. how Medicare sees it
There are two main categories of Medicare compliance: (1) reporting and (2) recovery. Although the law and regulations clearly state what must be done in each category…
Preparing for a fundamental compliance shift in liability claims
Liability claims are particularly at risk, as these emerging compliance issues impose new burdens on the management and settlement of claims.
Untangling the confusion of Accident & Health policies
Medicare compliance often requires that different policy types be grouped together into one set of claims. It’s the practice of the Centers for Medicare & Medicaid…
Top five tips to get a handle on conditional payments
Conditional payments are one of the biggest challenges insurers face when resolving a case with a Medicare beneficiary.
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…
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…
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…
Section 111: Navigating the forest, seeing the trees
At its core, Section 111 represents a way for Medicare to collect claim information on Medicare beneficiaries. The questions now revolve around what type of information…