Resources
ICD Lookup - Includes ICD-10 Codes
ExamWorks Compliance Solutions’ ICD Lookup is a complimentary web-based tool that assists our clients in looking up Medicare ICD codes for Mandatory Insurer Reporting. ICD Lookup contains all ICD-9 and ICD-10 codes currently accepted by Medicare for Mandatory Insurer Reporting (MIR), thus reducing potential exposure and penalties that could be incurred by a Responsible Reporting Entity (RRE).
To get started:
- Click here to access ICD Lookup search tool
- Select either ICD-9, ICD-10 Code lookup or Alleged Cause of Injury Code lookup
- Enter a keyword (e.g., “tibia” or “fall from ladder”) for an appropriate listing of codes
You can also do a reverse Search if a bill only documents a code. Enter the code in the keyword section and if the code is acceptable for MIR, then the description of the diagnosis or alleged injury will show for that ICD code.
Forms
ECS Referral form for use when requesting our services.
The BPOR is used in liability cases and some denied Workers' Compensation cases (when the beneficiary is listed as the debtor) and is signed by the beneficiary or their representative. It is used by ECS to determine Conditional Payments on a claim, dispute or appeal Conditional Payments on a claim and take any necessary action by the responsible paying entity to resolve Conditional Payments.
The BPOR is used in liability cases and some denied Workers' Compensation cases (when the beneficiary is listed as the debtor) and is signed by the beneficiary or their representative. It is used by ECS to determine Conditional Payments on a claim, dispute or appeal Conditional Payments on a claim and take any necessary action by the responsible paying entity to resolve Conditional Payments. (Spanish version)
The LOA is used for Workers' Compensation claims and is signed by the debtor or responsible paying entity. It is used by ECS to determine Conditional Payments on a claim, dispute or appeal Conditional Payments on a claim and to take any necessary action by the responsible paying entity to resolve Conditional Payments.
The LOA is used for Workers' Compensation claims and is signed by the debtor or responsible paying entity Parent Company. It is used by ECS to determine Conditional Payments on a claim, dispute or appeal Conditional Payments on a claim and to take any necessary action by the responsible paying entity to resolve Conditional Payments. In this scenario, ECS may utilize the Parent LOA for all of its subsidiaries.
This form may be used to document good faith efforts to identify a Medicare beneficiary where the injured party refuses to provide his/her necessary “Big 5” data (i.e. Legal Name, Date of Birth, Gender, Social Security Number / Medicare Number) for the purposes of Mandatory Insurer Reporting.
This form may be used to document good faith efforts to identify a Medicare beneficiary where the injured party refuses to provide his/her necessary “Big 5” data (i.e. Legal Name, Date of Birth, Gender, Social Security Number / Medicare Number) for the purposes of Mandatory Insurer Reporting. (Spanish Version)
The SSA release is used to request Social Security Disability Information (SSDI) from the claimant’s local Social Security office. From there, ECS is able to determine the claimant’s Medicare Eligibility by analyzing the SSDI report.
The SSA release is used to request Social Security Disability Information (SSDI) from the claimant’s local Social Security office. From there, ECS is able to determine the claimant’s Medicare Eligibility by analyzing the SSDI report. (Spanish version)
CMS requires this document signed and initialed by the claimant for a successful submission of any MSA
CMS requires this document signed and initialed by the claimant for a successful submission of any MSA. (Spanish version)
The HIPAA gives permission from the claimant to obtain medical records and/or pharmacy histories for use in Resolution and Pharmacy services
The HIPAA gives permission from the claimant to obtain medical records and/or pharmacy histories for use in Resolution and Pharmacy services. (Spanish version)
Useful Links
This guide outlines Centers for Medicare and Medicaid Service's (CMS) requirements to follow when developing a WCMSA.
A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid. CMS is part of the Department of Health and Human Services (HHS). Standards and guidelines for Medicare and Medicaid services and compliance are identified on this site.
If a beneficiary has Medicare and other health insurance, Coordination of Benefits (COB) rules decide which entity pays first. The purpose of the COB program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare payment.
This site provides an interface for Responsible Reporting Entities (RREs) impacted by the Medicare Secondary Payer (MSP) reporting mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007 (P.L. 110-173) to register their organization with the CMS.
The Benefits Coordination & Recovery Center (BCRC) consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries.
Unfamiliar with the acronyms used in the Medicare compliance and clinical services industry? Have a look at the PDF.
The only non-profit association addressing the Medicare Secondary Payer Statute and its impact on Workers’ Compensation and liability settlements.
WorkCompCentral provides industry news, professional training, and tools for workers' compensation professionals to do their jobs more efficiently
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