Medicare Secondary Payment Interest Calculation Tool Updated

The Medicare Secondary Payer Recovery Contractor (MSPRC) has published an updated version of its Interest Calculation Tool.

• Interest Periods tab
The Interest Periods tab gives you the ability to enter a specific demand date and calculate the exact day interest will be assessed each month thereafter for that demand.

• Demands before October 2004 tab
Demands that were issued prior to October 1, 2004 are handled slightly differently. This tab allows you to perform appropriate interest calculations that are tailored to these specific demands.

• How Interest is Calculated tab
Want to know how interest is calculated? This tab provides education on MSPRC's interest calculation process. This includes how the accrual of interest is calculated from day 1 of the demand letter date, the 60-day grace period to pay that amount, and how interest is assessed on the demand amount if the demand is not paid within the grace period. This tab also provides the actual formula for interest calculation to give you a better understanding of the process.Download the Excel based tool at: http://www.msprc.info/forms/Interest%20Calculation%20Tool%20(GHP%20&%20NGHP).xls

Related articles

• CMS Issues Series of Mandatory Reporting Alerts (workers-compensation.blogspot.com)
• CMS Extends Interim Dollar Reporting Threshold Date (workers-compensation.blogspot.com)
• Congress Told Workers Compensation is a Deteriorating System (workers-compensation.blogspot.com)
• New Jersey Issues Workers Compensation Guidance on Evaluating Disputed Medical Provider Claims (workers-compensation.blogspot.com)

CMS Issues Series of Mandatory Reporting Alerts

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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.

Related articles

• New Jersey Issues Workers Compensation Guidance on Evaluating Disputed Medical Provider Claims (workers-compensation.blogspot.com)
• Congress Told Workers Compensation is a Deteriorating System (workers-compensation.blogspot.com)
• CMS Extends Interim Dollar Reporting Threshold Date (workers-compensation.blogspot.com)

CMS Extends Interim Dollar Reporting Threshold Date

II. Extension of Current Dollar Thresholds for Liability Insurance
(Including Self-Insurance) and Workers’ Compensation

The interim dollar reporting thresholds set forth in Section 11.4 of version 3.1 of the MMSEA 111 Liability Insurance (Including Self-Insurance), No-Fault, and Workers’ Compensation User Guide have all been extended by one calendar year.

Under Section 11.4, “Workers’ Compensation ORM”, the date 12/31/2011 is changed to 12/31/2012.
Under Section 11.4, “Liability Insurance and Workers’ Compensation TPOC Amounts”, the last four bullets are revised to read:
• Claim reports where the last (most recent) TPOC Date is prior to January 1, 2013 with TPOC Amounts totaling $0.00 - $5,000.00, are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2013 with a total TPOC amount less than or equal to $5000.00 will be rejected.
• Claim reports where the last (most recent) TPOC Date is January 1, 2013 through December 31, 2013 with TPOC Amounts totaling $0.00 - $2000.00, are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2014 with a total TPOC amount less than or equal to $2000.00 will be rejected.
• Claim reports where the last (most recent) TPOC Date is January 1, 2014 through December 31, 2014, with TPOC Amounts totaling $0.00 - $600.00 are exempt from reporting. Initial claim reports (add records) with no ORM (ORM Indicator = ‘N’) where the most recent TPOC Date is prior to January 1, 2015 with a total TPOC amount less than or equal to $600.00 will be rejected.
• No threshold applies to claims where the last (most recent) TPOC Date is January 1, 2015 and subsequent.

November 09, 2010
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)&(b)(8))