CMS Changes Select NGHP MMSEA Reporting Fields from “Required” to “Optional” Effective 04/22/13

CMS, Medicare Set-Aside Blog on March 27, 2013 | Posted by Louis Jordan

Beginning 04/22/13, CMS is lightening the information gathering and reporting process for RREs in two areas: 1) Alleged Cause of Injury, Incident or Illness and 2) Claimant and/or Claimant Representative information that is currently required when the injured party is deceased (and claimant is not the injured party), including TINs for these Claimant(s) and Representative(s).

An ICD-9-CM External Cause of Injury Code (E Code) is currently required in order to classify the Alleged Cause of Injury, Incident or Illness for the claim that has been reported. In the past this field posed a problem, especially for RREs reporting liability TPOCs for which there was no physical or mental injury alleged, but required reporting because all medical claims were being released as part of the settlement. CMS created a no injury code (NOINJ) to address this situation. There were some reports that the NOINJ code was being overused and we can only assume that this field has continued to be problematic. It is also possible that the pending shift from ICD-9-CM to ICD-10-CM coding plays a role in this change as E codes will no longer be separated out as a supplementary classification under ICD-10-CM. Instead, they are incorporated under each main classification category and will no longer be prefaced with an E. Perhaps these factors combined led to CMS’ determination to eliminate the required reporting in this field. Regardless of the reason, it is favorable news for RREs.

RREs have also discussed the difficulties associated with obtaining information about additional Claimants/Representatives reported on the Claims Input File and, in some cases, the Auxiliary Record. These Claimants, identified with numbers 1-4, and their Representatives (attorneys/guardians/power of attorney) are currently required to be reported if the Claimant is not the Injured Party/Medicare Beneficiary. This generally arises with a wrongful death or survivorship action. While basic information about the additional Claimants may be known, more specific information such as TINs have been difficult to ascertain.

CMS states that although these entries will now be optional, they will be reviewed for validity if submitted. Errors in optional entries will be returned to the RRE with an error code.

The official Alert can be found here.