In Part 1, we reviewed disposition codes 01, 02, 03, 50 and 51. In Part 2, we will focus on the SP disposition code, which indicates an error within the claim submission. Why are these particular codes important to review? They are a performance indicator for either an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA’s self-reporting processes or reporting agent. The COBCCoordination of Benefits Contractor will reject an entire claim file if it finds that 20% of the records are in error, and while the COBCCoordination of Benefits Contractor has been lenient on releasing submissions, there are indications that this will get tighter as we move forward.
Continue reading 'A Technical Look at MIRMandatory Insurer Reporting Reporting Results (Part 2)'»
Whether you are an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA reporting claims to CMSCenters for Medicare and Medicaid Services directly or working with a reporting agent to report on your behalf, it is essential to understand the status of your claims and the results obtained. Most reporting agents understand how to transmit claims to CMSCenters for Medicare and Medicaid Services, but there are significant gaps in the industry amongst reporting agent strategies for CMSCenters for Medicare and Medicaid Services response files. Not understanding these differences could result in unnecessary work for your organization, frustrations in understanding your data, and substantial financial risk in the way of CMSCenters for Medicare and Medicaid Services fines. In the end, limiting risk is about successful submissions to CMSCenters for Medicare and Medicaid Services and understanding the responses CMSCenters for Medicare and Medicaid Services returns on claims. This analysis of the associated responses is crucial to understand the level of compliance an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA seeks to achieve.
Continue reading 'A Technical Look at MIRMandatory Insurer Reporting Reporting Results (Part 1)'»
On August 3, 2011 the GAOGovernment Accountability Office dismissed the protest filed by Data and Analytics Solutions, Inc. in reference to the WCRCWorkers’ Compensation Review Contractor contract awarded to Provider Resources, Inc. effective July 1, 2011. Data and Analytics Solutions, Inc. had filed a bid for the WCRCWorkers’ Compensation Review Contractor contract and was not chosen. They filed the protest alleging that the agency’s review process was flawed. The GAOGovernment Accountability Office was given a deadline of October 13, 2011 to render a decision in reference to the protest. The MSAMedicare Set-Aside industry is pleasantly surprised by such a quick decision by the GAOGovernment Accountability Office; the swift decision is welcome news so that the transition to the new WCRCWorkers’ Compensation Review Contractor provider can take place.
The transition of the WCMSAWorkers' Compensation Medicare Set-Aside review process from Lifecare Management Partners to Provider Resources, Inc. will soon commence. The industry is waiting to see whether the transition to a new contractor will improve the overall review and approval process and related turnaround times.
Click here to view a copy of the GAOGovernment Accountability Office Bid Protest Docket.
Click here to view the MedicareInsights.com July 14, 1011 post about the protest and delay.
Our July 29 post discussed a “handout” written by Ms. Sally Stalcup of Region VI of the Centers for Medicare and Medicaid Services (CMSCenters for Medicare and Medicaid Services). A case has recently been decided in the United States District Court for the Western District of Louisiana, Lafayette Division, which places Ms. Stalcup’s handout in proper context and perspective. For a copy of the handout, click here. In Schexnayder v. Scottsdale Insurance Company, 2011 U.S. Dist. LEXIS 83687, decided July 28, 2011, it becomes clear that the purpose of Ms. Stalcup’s handout was to respond to an inquiry made by the federal judge in this case.
In Schexnayder, the claimant was involved in an automobile accident while in the course and scope of his employment. The defendants in the case were two insurance carriers, a workers’ compensation carrier and a liability carrier. The defendants stipulated to liability, but strongly contested the reasonableness and necessity of the medical treatment and overall damages amount. This case involved a settlement for both a worker’s compensation and liability claim. CMSCenters for Medicare and Medicaid Services has stated that settlements involving both a workers’ compensation and third-party liability claim still require an MSAMedicare Set-Aside, as third-party liability proceeds are also primary to Medicare.
Continue reading 'Stalcup Handout Cited in Louisiana Federal Court Case'»
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