Cattie & Gonzalez, PLLC

Always enjoy attending Southern Association of Workers’ Compensation Administrators All Committee Conference. This year's conference in Amelia Island was incredible. Beautiful site, delicious food, amazing service, great opportunities to socialize, and the best speakers, work comp industry leaders, administrators, commissioners, legislators, and adjudicators from around the country. Thank you Desiree Tolbert, Malcolm Jennings, Evelyn McGill, Bob Wilson, BA, WRP, WRPA, Gary Davis, Pauline Williams, Paul Sighinolfi, Abbie Hudgens, Scott Wilholt, Frank McKay, Brittany O'Neil, Tom Glasson, CPCU, Andrew Sabolic, and Adam Fowler! #sawca #allcommitteeconference ??????https://lnkd.in/eV49UAva?????

Have you seen our article about Civil Monetary Penalty (CMP) Applicability & Enforcement Reminders from CMS? Number 7 on the list highlights that if an RRE is late in reporting Ongoing Responsibility for Medical (ORM) and Total Payment Obligation to Claimant (TPOC) more than one year, but less than two years, the daily civil money penalty is $250, which after adjusted for inflation in 2024 equals $357. Stay informed about regulations by following our firm! #RRE #CMP #Medicare

Although not as prevalent as Ongoing Responsibility for Medical (ORM) reporting errors, throughout our audits, we do see a volume of cases with Total Payment Obligation to Claimant (TPOC) reporting errors, including TPOC amounts, dates, and thresholds. Perhaps the most common error we see in TPOC reporting is with the amount. The TPOC amount refers to the dollar amount of a settlement, judgment, award, or other payment. The computation of the TPOC amount includes, but is not limited to, all Medicare covered medical expenses related to the claim, non-Medicare covered medical expenses related to the claim, all lost wages, property damages, attorneys’ fees, set aside amounts, payout totals for annuities, settlement advances, lien payments, and amounts forgiven by the insurer/carrier. #TPOC #MIR #Medicare

Have you seen our Civil Monetary Penalty (CMP) Applicability & Enforcement Reminders from CMS? Number 6 on the list highlights the penalty amount for noncompliant NGHP records, as per statutory authority at 42 USC 1395y(b) and the latest federal regulations. CMS emphasizes the daily penalty assessment per file for noncompliant NGHP records. Stay informed about regulations by following our firm! #CMS #CMP #Medicare

Ongoing Responsibility for Medical (ORM) Termination is frequently misreported, causing audit errors. The Responsible Reporting Entity (RRE) must accurately report the termination date without changing acceptance status or deleting records. Valid terminations occur when no medical care is needed, a claim is non-compensable, the claimant has died, or care is settled. Do not report a termination date if future payments are possible. Valid conditions for termination include no claims paid in five years, no medical implants, and total claims under $25,000. ORM termination must also adhere to state laws, insurance contracts, and physician recommendations. #ORM #RRE #MIR

We can't understate the importance of staying informed about CMS updates regarding Civil Monetary Penalties (CMPs) enforcement! CMS always emphasizes that the responsibility for submitting MSP records in a timely manner lies with the RRE, not the reporting agent. It's crucial to understand and adhere to these guidelines to avoid any legal issues. Stay updated to comply with regulations and ensure smooth operations. #CMS #RRE #Medicare

In our audits, a common error is the misreporting of ORM (Ongoing Responsibility for Medical). ORM Medical Codes do not guarantee ongoing medical care payment but reflect the current responsibility of the RRE. It's essential to report ORM with details about the illness, injury, and relevant ICD diagnosis codes. Codes starting in “Field 18” must adequately inform Medicare about the related medical care, as a common error involves reporting unrelated medical codes. #ORM #ICD #Medicare

We continue our top 20 updates and reminders series that highlights crucial updates from CMS regarding Civil Monetary Penalties (CMPs) enforcement. This is number 4! The focus is on Responsible Reporting Entities (RREs) and their reporting timelines. Stay informed! #CMS #RRE #Medicare

In our audits, a common error is the misreporting of ORM (Ongoing Responsibility for Medical). "Ongoing" refers to the RRE's (Responsible Reporting Entity) duty to cover medical care related to a claim, not to ongoing reporting of claims. An RRE assumes ORM when it learns of medical treatment linked to an injury, regardless of payment status. ORM typically takes effect from the injury date, aligning with when the RRE accepts responsibility. Payments made in a lump sum for ORM do not qualify as a TPOC (Total Payment Obligation to Claimant), as seen in no-fault situations like automobile insurance. #RRE #ORM #Medicare

We continue our top 20 updates and reminders series that highlights crucial updates from CMS regarding Civil Monetary Penalties (CMPs) enforcement. The focus is on Responsible Reporting Entities (RREs) and their reporting timelines. Stay informed! #CMS #RRE #Medicare