Data Elements
WHAT ARE THE 5 DATA ELEMENTS?
1-2)COMPLETE LEGAL FIRST AND LAST NAME
3)SSN
4)DATE OF BIRTH
5)GENDER
FORMATTING THE SSN LIKE THIS 999-99-1234?
WHAT DOES THIS MEAN?
Message - 01/01/2021 09:25:47 - LSP - Recipients :SZB
CMS: PLEASE COMPLETE THE INJURY DETAILS FOR
KELLY FEASEL FOR THE QUARTERLY CMS REPORT,
CURRENTLY DUE.
YOU NEED TO MAKE SURE THE PRIMARY INJURY DROP DOWN IS ACCURATELY SELECTED FOR THE RECIPIENT NOTED AND THAT THE TEXT BOX CONTAINS SPECIFIC INJURY DETAILS-YOU CAN SOMETIMES FIND THE ICD-10 CODES ON THE BILLS...
WHAT DO YOU DO WHEN YOU ARE UNABLE TO OBTAIN THE REQUIRED CMS DATA ELEMENTS?
CMS LETTERS
CMS LETTERS
CMS LETTERS
ISO SEARCHES, DATA SEARCHES
WHAT IS THE FINE FOR FAILING TO REPORT A MEDICARE ELIGIBLE CLAIMANT'S SETTLEMENT TIMELY TO MEDICARE?
$1000 PER DAY PER CLAIMANT. THE SETTLMENT MUST BE REPORTED IN THE FIRST QUARTERLY REPORT FOLLOWING THE SETTLEMENT. MED'S INCURRED SETTLEMENT DATE, IS THE DATE YOU ISSUE THE GENERAL DAMAGES PAYMENT.
123-45-6789-THE FULL SSN
FORMATTING THE SSN LIKE THIS: 000-01-2345?
WHAT DOES THIS MESSAGE MEAN?
Message - 01/01/2021 15:22:41 - LSP - Recipients :MBA
CMS MATCH FOR ADAM HERBISON, MBI: 1U11T24VK11
THIS MEANS THAT YOUR INJURED CLAIMANT IS A MEDICARE RECIPIENT. YOU WILL NEED TO KEEP THIS IN MIND WHEN RESOLVING THIS CLAIM. THERE MAY BE A MEDICARE LIEN THAT NEEDS TO BE ADDRESSED AS A CONDITION OF SETTLEMENT.
WHAT DO I DO IF THE INJURED PARTY OR THEIR REPRESENTATIVE STATE THE INJURED PARTY IS NOT A MEDICARE RECIPIENT?
DOCUMENT THE DATE, TIME AND THE NAME OF THE PERSON WHO PROVIDED YOU THAT INFORMATION IN THE FILE NOTES AND THE OCCUPATION/JOB DUTIES TEXT BOX-THEN SEND THE CMS LETTER.
ICD-10
A coding system used by physicians and other healthcare providers to classify all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.
EX: M542 Neck Pain
WHAT ARE 3 METHODS (THERE ARE MANY MORE) YOU CAN SELECT TO OBTAIN THE DATA ELEMENTS IF YOU ARE UNABLE TO SECURE THEM FROM THE INJURED CLAIMANT?
1)POLICE REPORT
2)ISO
3)DATA SEARCH
ENTER YOUR ATTEMPTS AT OBTAINING THE 5 DATA ELEMENTS IN THE PRIMARY INJURY TEXT BOX?
DON'T
(PUT ATTEMPTS IN THE FILE NOTES AND OCCUPATION/JOB DUTIES TEXT BOX)
WHAT SHOULD YOU DO WHEN YOU SEE THIS MESSAGE?
Message - 01/01/2020 13:21:00 - LSP - Recipients :TJH
CMS: ONE OR MORE ELIGIBILITY DATA ELEMENTS IS MISSING FROM THIS FILE FOR TRINISE ANDERSON.
START/CONTINUE/FINISH YOUR ATTEMPTS AT COLLECTING THE DATA: HAVE YOU SENT CMS LETTERS?? HAVE YOU DONE A DATA SEARCH??
WHAT GROUPS OF PEOPLE ARE MEDICARE ELIGIBLE?
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). If you are 65 or older and a citizen or permanent resident of the USA you or your spouse had to pay Medicare taxes while you worked to be eligible.
WHAT IS THE CMS MONTHLY QUERY?
We send monthly reports to CMS on all claimants with injury features, ONLY when the 5 required data elements are obtained and entered into the claims tree. Once CMS queries these individuals, we receive a report advising which ones are Medicare eligible. A claimant must be queried before their claim can be reported to Medicare.
WHEN SHOULD YOU START YOUR ATTEMPTS AT TRYING TO OBTAIN THE 5 DATA ELEMENTS?
AS SOON AS YOU ARE AWARE YOU HAVE A POTENTIAL INJURED CLAIMANT.
I SHOULD ASSUME ALL THE CMS DATA IS CORRECT WHEN I RECEIVE A TRANSFER FILE.
DON'T
DOES THIS MESSAGE REQUIRE ACTION ON YOUR PART?
01/01/2021 10:41:10 - LSP - Recipients :NMB
CMS: MORGAN RICHARDS IS OVER 65 AND NOT SHOWING AS ON MEDICARE. PLEASE VERIFY THE 5 DATA ELEMENTSFOR ACCURACY, INCLUDING FULL NAME AND SPELLING.
YES! DON'T IGNORE THIS MESSAGE. THIS MEANS THAT IT'S VERY LIKELY THAT ONE OF YOUR DATA ELEMENTS IS NOT CORRECT. WHEN YOU SEE THIS, DON'T JUST ASSUME THE DATA IS ACCURATE IF THE FIELDS ARE FILLED IN. DOUBLE CHECK THE DATA. CONTACT LSP IF YOU DON'T FIND ANYTHING INCORRECT-SHE CAN HELP.
WHEN IS OUR MONTHLY QUERY SUBMITTED TO CMS?
WHEN IS OUR QUARTERLY REPORTING SUBMITTED TO CMS?
QUERY: MONTHLY ON THE 8TH
REPORTING: QUARTERLY ON THE 8TH (JAN, APR, JUL, OCT).
WHAT IS THE CMS QUARTERLY REPORT?
We send quarterly reports to CMS on all claimants with injury features who, through the query process, have been identified as Medicare eligible. The information we need to report to CMS depends on what type of injury feature is open for that Medicare beneficiary. This is why it is SO important that you all enter the correct data into the correct fields as soon as possible.
IF YOU ARE UNABLE TO OBTAIN ALL 5 DATA ELEMENTS, HOW MANY TIMES SHOULD YOUR FILE REFLECT YOU ATTEMPTED TO OBTAIN THEM?
AT LEAST 3 TIMES
IGNORE ALL OF NICHOLE'S OR LSP'S EMAILS/MESSAGES REGARDING CMS.
WHEN LSP REFERENCES AN "MBI" WHAT DOES THAT MEAN?
MBI is an 11-character Medicare Beneficiary Identifier - or new Medicare Number (since 2018). If the injured party or their representative gives you an MBI, document your file with the number and send a system message to LSP.
WHAT DO YOU DO IF YOU HAVE ANY QUESTIONS REGARDING CMS?
ASK SOMEONE! LAURA PRENTICE, NICHOLE, YOUR TEAM LEAD, SUPERVISOR ETC...
HOW DO I EXPLAIN MY REQUEST FOR THE SSN WHEN THE INJURED CLAIMANT IS RELUCTANT TO PROVIDE IT?
Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 is a federal law that became effective January 1, 2009 and requires that liability insurers and no-fault (MP/PIP) insurers report specific information about Medicare beneficiaries who may have other insurance coverage. This reporting (complete spelling of your legal first and last name, date of birth, gender, and SSN or MBI) is to assist Medicare and other insurance plans to properly coordinate payment of benefits.
We are asking you to provide the requested information so that we may comply with this law.