A CMS Announcement! (06/05/23)

Yesterday, CMS published its latest updates to the Mandatory Insurer Reporting program in version 7.2 of its MMSEA NGHP User Guide found at https://www.cms.gov/files/document/mmsea-111-june-6-2023-nghp-user-guide-version-72-chapter-iii-policy-guidance.pdf

In this latest version of the User Guide, CMS clarified components of termination of ongoing responsibility for medical (ORM). Very specifically, an ORM termination date should only be submitted if one of the following criteria has been met:

• Where there is no practical likelihood of associated future medical treatment;
• Where the insurer’s responsibility for ORM has been terminated under applicable state law associated with the insurance contract;
• Where the insurer’s responsibility for ORM has been terminated per the terms of the pertinent insurance contract, such as maximum coverage benefits;
• Where there is no practical likelihood of associated future medical treatment, an RRE may submit a termination date for ORM if it maintains a statement (hard copy or electronic) signed by the beneficiary’s treating physician that no additional medical items and/or services associated with the claimed injuries will be required;

Where an RRE is relying upon a physician’s statement to terminate ORM, the ORM termination date to be submitted should be determined as follows:

• Where the physician’s statement specifies a date as to when no further treatment was required, that date should be the reported ORM termination date;
• Where the physician’s statement does not specify a date when no further treatment was required, the date of the statement should be the reported ORM termination date;
• Where the physician’s statement does not specify a date when no further treatment was required, nor is the statement dated, the last date of the related treatment should be used as the ORM termination date.

As always, you can count on Cattie & Gonzalez to keep you informed on the latest changes affecting Medicare's secondary payer program, including mandatory reporting, conditional payments, and future medical, by visiting us at www.cattielaw.com, calling us at 844.546.3500, or emailing us at info@cattielaw.com.