“Soft” Edits Debut Today in Section 111 Reporting

Today marks the first significant update in Section 111 reporting logic in several years.  In November 2020 the Centers for Medicare and Medicaid Services (CMS) announced a new classification of “soft” edits that will take effect today (April 5, 2021).  The information below outlines what “soft” edits are and how they will change the way… Read more »

CMS Announces Section 111 Technical Updates

On Thursday, January 21, 2021 the Centers for Medicare & Medicaid Services (CMS) released an updated Section 111 NGHP User Guide (back-dated to January 11, 2021).  While it contained nothing earth-shattering, there are a few important updates of note. CMS will now accept a claim with an ORM Termination Date that is up to 75… Read more »

PAID Act Becomes Law

This week Medicare updated the announcement to better define the scope of the proposal.

Maintaining Status Quo: CMS Retains $750 TPOC and Recovery Threshold

True to form, the Centers for Medicare & Medicaid Services (CMS) released another Alert during a holiday weekend.  This time, on the day before Thanksgiving Day, CMS announced that the Total Payment Obligation to the Claimant (TPOC) and Conditional Payment recovery thresholds for Workers’ Compensation, Liability, and No-Fault insurance claims remain unchanged at $750.  These… Read more »

CMS Announces Section 111 Technical Updates

On Thursday November 12th the Centers for Medicare & Medicaid Services (CMS) released an alert and an updated Section 111 NGHP User Guide to improve data quality efficiencies for Section 111 reporting services.  The updates will convert some data validation errors into “soft edits,” allowing the claims record to be processed despite minor data quality… Read more »