CMS and ISO ClaimSearch Medicare reporting service update
The U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) began implementing its Medicare Secondary Payer Reporting Program on January 1, 2011. In the past few months, there have been various updates to specific aspects of the program. As a result, ISO ClaimSearch® has enhanced its Medicare Secondary Payer (MSP) Reporting Service.
Changes to the timeline for reporting TPOC claims
In November 2010, CMS changed the date for required submission of liability insurance (including self-insurance) claim reports from the first quarter of 2011 to the first quarter of 2012 for all liability insurance TPOC (total payment obligation to the claimant) amounts with no ORM (ongoing responsibility for medicals) involvement. That change doesn't affect liability insurance (including self-insurance) ORM reporting.
Liability insurance TPOC claims must now be reported if the TPOC date falls on or after October 1, 2011, rather than the previous date of October 1 2010.
If you've already marked your liability claims with the "Medicare eligible indicator = yes" and the TPOC date, ISO will send your claims to CMS during your first quarterly reporting period. If you don't want ISO to report those claims to CMS, you must do one of three things on each claim:
- remove the Medicare-eligible indicator
- remove the TPOC date
- add the "Do not send this coverage to CMS" indicator
If your claim contains both TPOC and ORM coverage types, ISO will send the no-fault portion of the claim (ORM) to CMS during your first quarterly reporting period. ISO will send the TPOC portion of your claim to CMS if you've provided the TPOC date and have not marked the "Do not send this claim to CMS" indicator.
ISO ClaimSearch will change its programs to stop querying all liability TPOC claims with closing dates prior to October 1, 2011. (Please note: ISO ClaimSearch will continue to query TPOC claims without closing dates.)
ICD-9 code lookup tool now available on ISO ClaimSearch MSP reporting service
CMS requires at least one ICD-9 (international classification of disease) diagnosis code and cause-of-injury code for new records submitted on or after January 1, 2011. ISO ClaimSearch Medicare Secondary Payer Reporting Service now provides a lookup tool that identifies appropriate ICD-9 and cause-of-injury codes when reporting claims on the web. To minimize the need for interpretation of search results, the tool will provide only valid codes that have been approved by CMS for reporting purposes.
ISO ClaimSearch MSP Reporting Service participants can find the new feature on the General Casualty Information page of the Claims Reporting section of the ISO ClaimSearch website. The site offers a free-form search function allowing for the retrieval of both ICD-9 and cause-of-injury codes using one of the following criteria:
- description of the injury or illness
- partial/complete ICD-9 code
Once the search function locates the appropriate code, you can then copy and paste it into the fields on ISO ClaimSearch designated for CMS reporting.