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Showing posts with label State Children's Health Insurance Program. Show all posts
Showing posts with label State Children's Health Insurance Program. Show all posts

Sunday, October 2, 2011

New CMS Policy Announced: Asbestos Exposure, Ingestion, and Implantation Issues and December 5, 1980

The Centers for Medicare & Medicaid Services has consistently applied the Medicare Secondary Payer (MSP) provision for liability insurance (including self-insurance) effective 12/5/1980. As a matter of policy, Medicare does not assert a MSP liability insurance based recovery claim against settlements, judgments, awards, or other payments, where the date of incident (DOI) occurred before 12/5/1980.

When a case involves continued exposure to an environmental hazard, or continued ingestion of a particular substance, Medicare focuses on the date of last exposure or ingestion for purposes of determining whether the exposure or ingestion occurred on or after 12/5/1980. Similarly, in cases involving ruptured implants that allegedly led to a toxic exposure, the exposure guidance or date of last exposure is used. For non-ruptured implanted medical devices, Medicare focuses on the date the implant was removed. (Note: The term “exposure” refers to the claimant’s actual physical exposure to the alleged environmental toxin, not the defendant’s legal exposure to liability.)


In the following situations, Medicare will assert a recovery claim against settlements, judgments, awards, or other payments, and the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 MSP mandatory reporting rules must be followed:

• Exposure, ingestion, or the alleged effects of an implant on or after 12/5/1980 is claimed, released, or effectively released.

• A specified length of exposure or ingestion is required in order for the claimant to obtain the settlement, judgment, award, or other payment, and the claimant’s date of first exposure plus the specified length of time in the settlement, judgment, award or other payment equals a date on or after 12/5/1980. This also applies to implanted medical devices.

• A requirement of the settlement, judgment, award, or other payment is that the claimant was exposed to, or ingested, a substance on or after 12/5/1980. This rule also applies if the settlement, judgment, award, or other payment depends on an implant that was never removed or was removed on or after 12/5/1980.

When ALL of the following criteria are met, Medicare will not assert a recovery claim against a liability insurance (including self-insurance) settlement, judgment, award, or other payment; and MMSEA Section 111 MSP reporting is not required. (Note: Where multiple defendants are involved, the claimant must meet all of these criteria for each individual defendant in order for a settlement, judgment, award, or other payment from that defendant to be exempt from a potential

MSP recovery claim and MMSEA Section 111 reporting):

•All exposure or ingestion ended, or the implant was removed before 12/5/1980; and

•Exposure, ingestion, or an implant on or after 12/5/1980 has not been claimed and/or specifically released; and,

•There is either no release for the exposure, ingestion, or an implant on or after 12/5/1980; or where there is such a release, it is a broad general release (rather than a specific release), which effectively releases exposure or ingestion on or after 12/5/1980. The rule also applies if the broad general release involves an implant.

For Specific Examples Click Here To Read the CMS Memo

REPORTING REMINDER:

Information related to the MMSEA Section 111 MSP reporting requirements can be found at
www.cms.hhs.gov/MandatoryInsRep. When reporting a potential settlement, judgment, award, or other payment related to exposure, ingestion, or implantation, the date of first exposure/date of first ingestion/date of implantation is the date that MUST be reported as the DOI. This is true for purposes of individual self-identification of a pending claim to the Centers for Medicare & Medicaid Services’ Coordination of Benefits Contractor, as well as for MMSEA Section 111 reporting.

Related articles

Thursday, December 2, 2010

CMS Issues Series of Mandatory Reporting Alerts

Centers for Medicare and Medicaid Services (Me...Image via Wikipedia
The Centers for Medicare and Medicaid Services (CMS) has recently issued a series of Alerts for Implementation of Medicare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (See 42 U.S.C. 1395y(b)(7) & (8)).


One of Alerts defines the Date of Incidence (DOI) for a cumulative injury which is the earlier of:

• The date that treatment for any manifestation of the cumulative injury began when such treatment preceded formal diagnosis; or
• The first date that formal diagnosis was made by any medical practitioner.



MMSEA 111 - Alert - November 18, 2010 - ALERT: Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers' Compensation - Special Default ICD-9 Code for Responsible Reporting Entities (RREs) [PDF 69.45KB] 

MMSEA 111 - Alert - November 18, 2010 - ALERT:  TIN Reference File Address Validation Information for Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers' Compensation Responsible Reporting Entities (RREs) [PDF 58.76KB] 

MMSEA 111 - Alert- November 9, 2010 - I. Revised Implementation Timeline for TPOC Liability Insurance (Including Self-Insurance) Settlements, Judgments, Awards or Other Payments and II. Extension of Current Dollar Thresholds for Liability Insurance (Including Self-Insurance)  and Workers' Compensation [PDF 46.95KB] 

MMSEA 111 - Revised Alert - November 5, 2010 - Direct Data Entry (DDE) Registration Information for Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers' Compensation [PDF 49.17KB] 

MMSEA 111 – Revised Alert - November 5, 2010 - New Direct Data Entry (DDE) Option for Liability Insurance (Including Self-Insurance), No-Fault Insurance and Workers' Compensation [PDF 65.37KB] 

MMSEA111 - Alert - October 14, 2010 - Alert For Liability (Including Self-Insurance), No-Fault Insurance and Workers' Compensation - Reporting Timeframe [PDF 44.34KB] 

MMSEA111 - Alert - October 14, 2010 - Alert For Liability (Including Self-Insurance), No-Fault Insurance and Workers' Compensation - DOI For Cumulative Injury [PDF 40.89KB] 


New information concerning ICD Provider & Diagnostic Codes has also been posted to the CMS website:
Version 28 Full and Abbreviated Code Titles - Effective October 1, 2010 [ZIP 922KB] 


Conversion information to the proposed (NEW) ICD-10 Codes is also posted.