Anders: CMS Releases Technical Updates to Part 111 Consumer Information| Staff Compensation Information

By Then different

Wednesday, January 27, 2021 | 52 | 0 | min read

The Centers for Medicare and Medicaid Services started the new year with some updates to their MMSEA Section 111 NGHP User Guide. This guide contains everything you ever wanted to know about mandatory coverage by non-group health insurance companies.

Then different

Version 6.2 offers the following updates:

Reporting threshold of USD 750

In a follow-up to its November 2020 announcement to maintain the TPOC threshold of $ 750 for reporting and contingent recovery of Medicare payments, CMS states:

As of January 1, 2021, the threshold for liability insurance based on physical trauma will remain at $ 750. CMS will maintain the $ 750 threshold for no-fault insurance and employee compensation statements if the no-fault insurer or employee compensation agency otherwise has no ongoing responsibility for medical care (Sections 6.4.2, 6.4.3 and 6.4.4).

Key to take away: Compliance with the $ 750 threshold means that no changes have been made to reporting processes, determining which claims to report, or investigating or resolving contingent payments.

Notification of the future ORM termination date

Via CMS:

To address situations where Responsible Report Entities (RREs) can identify future ORM termination dates based on the terms of the insurance contract, RREs can now set a future physician ongoing responsibility termination (ORM) date (field 79) up to Enter 75 years from the current date Date (Section 6.7.1)

Key to take away: A future ORM termination date can only be submitted if it is certain, e.g. B. the date is specified in an insurance contract or a legal restriction provides for its precise determination. The previous policy only allowed reporting of an ORM termination date that was six months in the future. The extension to 75 years should allow most date-specific ORM cancellations to be reported.

Data exchange update

Via CMS:

As part of CMS ‘commitment to modernizing the Coordination of Benefits & Recovery (COB&R) operating environment, changes are being made to bring certain electronic data transfer data to the CMS Enterprise File Transfer (EFT) protocol. As part of this change, data exchange with the COB & R program via Connect: Direct to GHINY SNODE will be discontinued. The final change is to take place in April 2021. The naming conventions for files and other references have been updated in this guide. Please contact your EDI representative for more information (sections 10.2 and 10.3).

Key to take away: Currently, CMS offers four data transfer methods that Section 111 RREs or their reporters can use to send and receive electronic files. CMS discontinues the Connect: Direct method. Since Tower does not communicate with CMS through this method, it does not affect our reporting processes.

Policy number now a key field

Via CMS:

To support previous system changes, the policy number (field 54) has been added as a key field. If this field changes, RREs must send a record for the delete claims input file that matches the previously accepted add record, followed by a new add record with the changed information (i.e. delete / add process) ( Sections 6.1.2, 6.6.1, 6.6.2 and 6.6.4).

Key to take away: If a claim input file was previously updated with a different policy number for the same claim, two records were created using the BCRC. This could double Medicare’s contingent recovery efforts. CMS’s solution is for the RRE to delete the previous record with the old policy number and add a new record with the new policy number.

Withdraw the softcode error

Via CMS:

In version 6.1 we announced that several input errors will become “soft” errors from April 5, 2021. However, CP03 does not become soft machining. The Office Code / Site ID (field 53) that triggers CP03 is used to identify correspondence addresses and, if wrongly reported, can result in emails being sent to the wrong location. Therefore, this error continues to reject the data set (Appendix F).

Key to take away: An error in the Office Code / Site ID (field 53) is not considered a soft edit and will result in the rejection of files. In an earlier Tower article, November CMS Mandatory Reporting and Conditional Payment Updates, these so-called “soft” code errors were discussed.

Dan Anders is the Chief Compliance Officer at Tower MSA Partners LLC. This entry is republished with permission from the Tower MSP Compliance Blog.