CMS Issues Alert Concerning Delay of Transition to ICD-10 Codes

President Obama signed into law the Protecting Access to Medicare Act of 2014. The new law delays the implementation of ICD-10 codes from October 1, 2014 to October 1, 2015. As a result of this new law, CMS has issued notice that, effective immediately, Responsible Reporting Entitles are to postpone reporting ICD-10-CM diagnosis codes on their production Claim Input File and Direct Data Entry (DDE) submissions until

October 1, 2015. RREs may continue to submit ICD-10-CM diagnosis codes on test Claim Input File submissions.
 
The full text of the CMS alert can be found at: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/Delay-in-transition-from-ICD-9-CM-diagnosis-codes-to-ICD-10-CM-diagnosis-codes-for-Liability-Insurance-Including-Self-Insurance-No-Fault-Insurance-and-Workers-Compensation.pdf

Some Workers' Compensation Courts Recognize the Importance of Considering Medicare's Potential Interests in Every Case

Medicare Secondary Payer Act compliance has become such a commonplace concern that some courts recognize the need to consider this issue in every workers' compensation claim that settles. A prime example of this is Nebraska's workers' compensation court, which requires, pursuant to Rule 47(B)(12) of its rules of procedure, that every application identify whether the claimant is a Medicare beneficiary, is eligible for Medicare, or has a reasonable expectation of becoming eligible for Medicare within 30 months of the settlement's execution. The rule further provides that if the claimant has a reasonable expectation of becoming a Medicare beneficiary within 30 months, the application should further identify the date of expected Medicare eligibility. If the claimant is actually a Medicare beneficiary at the time of the settlement's execution, the application must acknowledge the status of conditional payment claims research and that the employer will be responsible for Medicare's asserted, related claims.

 

This blanket approach to evaluate Medicare's potential interest in every case is laudable, and we encourage defendants to approach their settlements in this way (even if the governing court does not mandate that an application include this language). We would further encourage the parties to consider the use of a Medicare Set-aside in those cases with Medicare beneficiaries (or with claimants who have a reasonable expectation of becoming a beneficiary within 30 months of settlement). Of course, a Medicare Set-aside's calculation and creation depends upon a number of factors. We welcome the chance to assist parties with their analysis of these issues, regardless of whether it is on a case-by-case basis or whether it is in the development of consistent, internal procedures and policies.

Don't Forget to Report Termination of ORM!

It is important to remember to report termination of ORM once the RRE’s responsibility for paying for medical expenses ends, such as through closure of future medical expenses in workers’ compensation cases and exhaustion of policy limits for no-fault claims. In situations where ORM has ended and it would otherwise be appropriate for Medicare to pay for treatment related to an injury at issue in the claim, it is particularly important for termination of ORM to be reported promptly. Otherwise, Medicare will very likely continue to deny payment for any treatment related to the injury.

In order to avoid Medicare continuing to deny payment for the claimant’s treatment, RREs have the option of making an immediate report of termination of ORM by calling Medicare’s Benefits Coordination and Recovery Contractor at 1-855-798-2627. It is important to note that reporting termination of ORM by phone does not relieve the RRE from responsibility to electronically report termination of ORM.

RREs may also report termination of ORM electronically prior to their next quarterly file submission period. CMS allows RREs to submit claim input files outside of their assigned file submission period, which CMS has indicated is primarily for the purpose of allowing RREs to more quickly report termination of ORM. RREs cannot submit more than one claim input file every 14 days, and RREs must still submit a claim input file during their assigned file submission period even if another claim input file has already been submitted during the quarter.