Update on Implementation of ICD-10 Codes for MMSEA Reporting

On April 1, 2014, President Obama signed H.R. 4302, the “Protecting Access to Medicare Act of 2014” which postpones the implementation of ICD-10 codes. Per Section 212 of the Act, the Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets.

ICD-10 codes are being implemented to provide additional information about patients’ medical conditions and inpatient procedures. Current ICD-9 codes are mostly numeric and contain 3 to 5 characters. ICD-10 codes are alphanumeric and contain 3 to 7 characters, allowing the codes to be more descriptive.

We will continue to monitor this legislation, and will report future developments.






Friday FAQ: Medicare Part C Plan Liens

Question: If a medicare beneficiary opts out of traditional Medicare and uses a BCBS, Humana, AARP plan, and is in an accident and is not put on notice via the replacement plan, is our firm and the beneficiary required to notify the insurance plan of a possible lien/claim? Answer: It would appear that your question…


When Can a Plaintiff Attorney Take Fees on WCMSA?

On March 19, 2014, a Louisiana appellate court rendered judgment in Benoit v. MMR (2014 La. App. LEXIS 716). There, the issue before the court was whether plaintiff attorneys were entitled to collect fees on the seed money portion of the Workers’ Compensation Medicare set-aside Arrangement (“WCMSA”) as determined by the parties and approved by…


Friday FAQ: What if my client will not set funds aside for future medicals?

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3 Things You Need to Know About the Change in MMSEA Reporting Thresholds

On February 28, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued an alert which increases the Section 111 mandatory reporting threshold for a Total Payment Obligation to Claimant (“TPOC”) agreed to on or after October 1, 2014. Following the Alert, CMS issued a new User Guide on March 3, 2014. The mandatory reporting…