CMS Open Door Forum Teleconference Recap

Medicare Set-Aside Blog on June 19, 2012
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Here are highlights from today’s CMS Town Hall Meeting. Further details are available here.


New Alerts and User Guide published late June but NLT July 4th.

New User Guide is more user friendly format with links, etc. Will keep the old UG around for a while until everyone feels comfortable with the new format.

Listserve for updates published to web site isn’t working well so everyone should also watch the COBCSW for notification of new Alerts/User Guide. They will be published there as well.

With the integration contractor award, they hope to complete transitions by year end. Their ability to implement any Section 111 changes will be limited during this period. After the July release of Alerts/UG, unlikely to be much activity related to Section 111 during the transition process.

Regarding submission of multiple claim input files in any given quarter – although multiple files will be accepted, they can still only be sent one at a time. A new file cannot be submitted until there is a response from the prior file (which could be up to 45 days). They expect that a bulk of an RREs data will continue to be submitted during their assigned submission week each quarter with any additional files being smaller. If the RRE cannot submit during their assigned period because there is an outstanding claim input file that is still being processed, the RRE will not be penalized but they strongly suggest that the RRE be cognizant of the assigned reporting period and not submit a voluntary claim input file in the few weeks prior to the assigned reporting period (they say this assuming that most extra submissions will be smaller and only take 2-3 weeks to process).

There were three callers who claim that the call center operators (1-800-MEDICARE) are giving out the direct phone number to the RREs authorized representative to call regarding the Medicare claim denials. State Farm reported that their authorized representative receives 5-10 calls per day from injured parties re: Medicare claim denials. COBC adamantly disputes this and says that it is not possible because the operators do not have access to this information and that in State Farm’s case they listed the authorized rep’s phone number as the company phone number (State Farm caller disputed that and said that had been corrected). The injured parties/Medicare beneficiaries are calling to ask them to terminate ORM so that their claims can be paid. The denials themselves are a big problem, but as you can imagine, even a bigger issue that they are getting RRE’s authorized representatives on the phone. After the State Farm caller there were two others who offered that they were having the same issue and one actually changed their authorized rep phone number on file to the account manager, who is now dealing with fielding the calls.

Awful story re: denied claims due to Section 111 reporting. Terminal illness with claims being denied (unrelated to the injury). This was a Sedgwick case and they almost terminated ORM just so she could get her treatment. Instead they called into EDI dept and the issue was corrected…she finally got her treatment for her unrelated issues and then died 6 days later. RREs are finding themselves in some sticky situations.