Centers for Medicare and Medicaid December 24, 2015 Alert

On December 24, 2015, the Centers for Medicare and Medicaid Services released an Alert titled “Changes to Medicare Claim Payments Where Ongoing Responsibility for Medicals (ORM) is Reported.” Effective January 1, 2016, in situations where an insurer has reported to CMS that it has ongoing responsibility for medicals for specific care or an injury, CMS’ claims processing contractors will use the information provided by the insurer to determine whether Medicare is able to make primary payment for those claims. When an insurer notifies Medicare that it has ongoing responsibility for medicals the insurer must report accurate ICD-9 to ICD-10 codes or claims processing contracts will not be able to determine who has primary versus secondary payment responsibility. If you have questions or concerns about this CMS update or the appropriate use of ICD-9 and ICD-10 codes, please contact me.

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