ORM
A primary payer, like a WC insurer or a Liability insurer, has assumed responsibility for paying a Medicare beneficiary's medical expenses related to a specific injury or illness.
What is ORM?
$750
What is the current TPOC reporting threshold?
Medicare and Workers Compensation Fee Schedule
What are Fee schedules that WCMSA beneficiaries are entitled too.”
Three reasonable attempts to obtain information for reportable beneficiaries by mail, email or phone call.
What are good faith attempts or safe harbor.
Code 01 indicates TPOC submitted more than 135 days, code 02 indicates invalid ICD format, code 03 indicates ORM Term submitted more than 135 days, and Code 04 indicates the later of date of loss or Part A Add Date submitted more than 135 days.
What are Warning Flags?
Ensures that Medicare properly coordinates benefits, and that the RRE is not held responsible for future medical expenses that are no longer their responsibility.
What is the importance of accurate and timely reporting of the ORM termination date?
10/11/2011
What is the first liability TPOC date that RREs were required to report?
Case ID and Professional Administration EIN
What are “optional fields” for S111 reporting of WC MSA fields.
365 days
what is the compliance period.
A file showing records submitted by an RRE that were updated by an entity other than the RRE over the last month.
What is the unsolicited response report?
The associated “lost time” is no more than the number of days permitted by the applicable workers’ compensation law for “medicals only” (or 7 calendar days if applicable law has no such limit); and
· All payment(s) has/have been made directly to the medical provider; and
· Total payment for medicals does not exceed $750.00.
What are Workers Compensation criteria for claims that do not require reporting of ORM?
The date the payment obligation was established
What is the TPOC date for purposes of Section 111 reporting?
85%
What is the annual percentage of individuals who choose to self administer their MSA”
The first letter sent to the RRE when a record was identified as non compliant
what is the Informal Notice – Intent to impose a Civil Money Penalty
Delete records exceed 5% of the entire file, 20% or more of the total records failed due to errors, TPOC amount or NFIL exceeds 100 million dollars.
What are threshold errors?
Field 85 must remain as ‘Y’ (for yes). The ‘Y’ indicates current ongoing responsibility for medicals only until a termination is reported. Once the termination date is reported, the ‘Y’ reflects the existence of ongoing responsibility for medicals prior to the termination date.
What is how to report the ORM termination date?
Error code that indicates a record was reported via Section 111 with ORM Indicator as no and the cumulative TPOC amount is zero
What is a CJ07 error?
DAILY DOUBLE!!!
Future medicals and protecting Medicare’s interest
What is the purpose of a WCMSA
250 records
What is the random selection of audits across all RREs (GHP and NGHP) per quarter.
The RRE and its agent shall establish appropriate administrative, technical, procedural and physical safeguards to protect the confidentiality of the data and prevent unauthorized use.
What is safeguarding data in the RRE Profile Report?