Section 111
These are the five pieces of information needed to complete the Medicare query.
What are: Medicare ID #, first name, last name, date of birth and gender?
This entity is the one who usually seeks reimbursement from the applicable plans. (Full name)
What is the Commercial Repayment Center?
This product is useful in states that do not settle medical.
What is the Medicare Reserve Account (MRA)?
In professional administration, this is who decides whether or not treatment is related to the injury (and thus MSA funds can be used).
Who is the treating doctor?
Amended reviews. Cases need to be at least ____ months old but not more than ____ months old.
What is 12 months and 72 months?
An organization that must report under Section 111 is referred to as this - often shorted to three letters.
What is a Responsible Reporting Entity (RRE)?
Interest begins to accrue this many days from the date if the initial determination.
What is 60 days?
These are the two calculation methods that CMS uses to determine the pricing/amount for future medical treatment
What is the state fee schedule or actual/usual & customary?
There is one situation where we (NuQuest) require that professional administration be used on a settling case.
What is a NuShield case that has been submitted to CMS?
This is the current version number of the WCMSA Reference Guide?
What is the WCMSA Reference Guide 3.2?
Term used when an RRE has continuing responsibility to pay for the injured party/Medicare beneficiary's medicals that are associated with the claim.
What is Ongoing Responsibility for Medicals (ORM)?
This amount refers to the dollar amount of a settlement, judgment, award or other payment - in addition to or apart from ORM - to a Medicare beneficiary.
What is the Total Payment Obligation to the Claimant (TPOC)?
MSAs include prescriptions that are listed on the pharmacy history. This is another source/location where a prescription may be shown/noted and therefore will be included in the MSA.
What are physician dispensed drugs?
WCMSA Reference Guide requires that the WCMSA funds be deposited into what type of account?
What is an interest-bearing account that is separate from any other account?
Switching to annuity funding from a CMS determination approved as a lump sum requires this.
What is a document signed by the claimant?
This is the current mandatory TPOC threshold amount for both WC and liability.
What is $750?
This is where we go to find the lien amounts related to MAP plans.
Where is the specific companies themselves?
On NuShield cases, when dealing with denied conditions, what do we need to know about those denied conditions?
This needs to be sent to CMS once the WCMSA account becomes permanently depleted.
What is a final attestation?
What is 1. a mathematical error or 2. information dated prior to submission?
Reporting is accomplished by either the submission of an electronic file (of the liability, no-fault, and workers’ compensation claim information) or by this.
What is Direct Data Entry (DDE)?
Patrick always tells us that we should not just be concerned with whether the charges on a CP letter are related/unrelated, we should be looking at this.
What is disputable charges?
To get a SCS or a surgery/treatment removed from an MSA, this needs to be done.
What is that a treater needs to state it is no longer medically necessary? Or, that a court of competent jurisdiction after a hearing on the merits makes a ruling.
This is what happens to the WCMSA funds if claimant/Medicare beneficiary loses their Medicare entitlement.
What is nothing - they are not entitled to a release of their funds?
The new Consent to Release that we started using this year required what additional action by the claimant/
What is a requirement that they initial beside a sentence saying that they have had the need and process for the MSA explained to them?