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.