DULAC, Inc. Medical Malpractice Claims - Integrity. Experience. Innovation. Service

The January 2012 newsletter of the National Practitioner Data Bank contains detailed information on upgraded reporting features. These features will streamline medical malpractice claims reporting protocols. In particular, the NPDB is in the process of implementing an electronic protocol for filing NPDB reports with the related state licensing entity. The NPDB advises that, One of [...]

Alternative dispute resolution affords parties in medical malpractice claims an opportunity for self-determination and efficiency in an amicable and confidential environment. We have participated in, and directed negotiations at, thousands of mediations, voluntary and mandatory settlement conferences, and informal settlement meetings. Formal mediation is an extraordinarily useful and productive element of this medical malpractice alternative [...]

CMS has published a quick reference guide for MMSEA Section 111 Reporting. The Guide is specifically furnished for Non-Group Health Plan (NGHP) Responsible Reporting Entities (RRE). The full document is located at: https://www.cms.gov/MandatoryInsRep/Downloads/NGHPQuickRef.pdf Our solution to the logistical and substantive challenges of MMSEA Section 111 features complete reporting service. Our resources will extract and review [...]

Effective and credible claims administration requires not only substantive capabilities but also a logistical foundation. Management of files via electronic storage and administration has become an efficient and preferred methodology. One of the important considerations to establish, or accomplish transition to, electronic claims file management is the comprehensive electronic sorting of written materials. A myriad [...]

The Office of Public Information of the Supreme Court of Ohio published the following release on December 8, 2011: “Court Rules Expert Testimony Needed to Show Undisclosed Medical Risk Actually Caused Injury Where Patient Claims ‘Lack of Informed Consent’ to Medical Procedure Please note: Opinion summaries are prepared by the Office of Public Information for [...]

DULAC, Inc. is pleased to be an advertising sponsor of the Bar Journal of the Cleveland Metropolitan Bar Association. The November, 2011, issue features articles by various authors on class actions, federal pleading standards, and an introduction to the newly-formed Insurance Law Section. The latter is particularly apropos given the adoption by the Supreme Court [...]

During the course of its Town Hall Teleconference on November 16, 2011, a representative of CMS reiterated the importance of accurate reporting of applicable ICD-9 Codes on MMSEA Section 111 reports. He indicated that Responsible Reporting Entities (RREs) should only include injury codes that are related to the underlying claim that is the subject of [...]

Tampa, FL — November 8, 2011 DULAC, Inc. and RiskQual Technologies, Inc. announce the formation of a strategic partnership that provides innovative and advanced solutions to the risk management, claims administration, and MMSEA Section 111 issues that confront hospitals and health systems in an ever-evolving regulatory and compliance environment. The convergence of advanced data management [...]

The requirements of MMSEA Section 111 are an integral element of the overall mandates of Medicare Secondary Payer (MSP). A comprehensive approach to MSP compliance includes substantive review of reporting elements, utilization of Medicare Set-Aside Arrangements (MSA), and consideration of insuring ancillary risk exposure. As noted in this excerpt from the Ironshore press release of [...]

We are pleased to be an advertising sponsor of the Bar Journal of the Cleveland Metropolitan Bar Association, October 2011 edition. We feature links to our complete MMSEA Section 111 reporting services. This is a topic of current urgency as the Centers for Medicare and Medicaid Services (CMS) advised that Section 111 reporting on liability [...]

MMSEA Section 111 reporting remains a significant logistical and substantive issue for liability insurers. CMS published a series of Alerts on Friday, September 30, 2011, immediately prior to the commencement of the existing timeline pertaining to reporting of liability claim Total Payment Obligation to the Claimant (TPOC). Perhaps the Alert of the most significant general [...]

The September, 2011 issue of the Bar Journal of the Cleveland Metropolitan Bar Association has been published. Once again, we are pleased to be an advertising sponsor of this excellent publication and organization. Our solution to the logistical and substantive challenges of MMSEA Section 111 features complete reporting service. Our resources will extract and review necessary [...]

CMS advises that the newest edition of the MMSEA Section 111 User Guide (Version 3.2) has been posted to the website.  The Guide, and other materials relevant to MMSEA Section 111 reporting, can be located at:  www.cms.gov/mandatoryinsrep We are in the process of reviewing the updated edition, and will look forward to posting more information. [...]

We are pleased to be an advertising sponsor of the Annual Meeting edition (July/August, 2011) of the Journal of the Cleveland Metropolitan Bar Association.  We feature our complete MMSEA Section 111 reporting services as well as medical malpractice claims administration. Our solution to the logistical and substantive challenges of MMSEA Section 111  features complete reporting service.  Our [...]

Our continued discussion addresses areas of ancillary risk exposure that result from incorrect MMSEA Section 111 reports, above and beyond the Civil fines and penalties.   Even though the RRE has the nexus with the agency as far as the obligation to file reports, we nevertheless see that there is privity in essence between the RRE and [...]

The Centers for Medicare and Medicaid Services (CMS) website indicates the scheduling of Town Hall Teleconferences for MMSEA Section 111 reporting as follows: August 24, 2011  NGHP Policy September 21, 2011 NGHP Technical October 19, 2011  NGHP Policy The website also has the schedule for GHP teleconferences. Our solution to the logistical and substantive challenges of [...]

The purpose of MMSEA Section 111 reporting is to assist with the collection of information that the  Coordination of Benefits Recovery Contractor (COBRC) will use to determine primary versus secondary payer status of Medicare in situations of payments made to Medicare beneficiaries by Applicable Plans, otherwise defined as Responsible Reporting Entities (RRE).  The reporting requirements are in addition [...]

CMS conducted its most recent Town Hall Teleconference on June 29, 1011.  A check of the CMS website does not show a schedule of future sessions for 2011.  We expect that more teleconferences will be added and will look for publication of an Alert from CMS with an enhanced schedule.  CMS has indeed been diligent [...]

The MMSEA Section 111 Reporting Agent Educational Forum, a LinkedIn group we established on October 9, 2009, has now reached a membership of 250. We  founded the group to facilitate dialogue on the substantive and logistical aspects of the MMSEA Section 111 reporting obligations, which are quite complex and subtle.  We are most appreciative of [...]

We  took part in the development of a new and robust Medicare Reporting and Secondary Payer Act Liability (MRSPAL) Insurance Policy underwritten by a major North American insurance company.  Our efforts focused on the conceptual foundations of the policy, designed specifically to insure the risks associated with MMSEA and MSP.  In addition to the Civil Fines [...]

In order to comply with the mandates of Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), it is necessary for organizations that are subject to the Mandatory Insurer Requirements (MIR) to determine the manner in which the logistical aspects of reporting will be fulfilled.  An “Applicable Plan” of insurance (including [...]

During the CMS Town Hall Teleconference on June 29, 2011, discussing MMSEA Section 111 Reporting, a CMS representative advised that there is not any more information forthcoming to aid Ohio self-insured employers participating in the “15K Plan”.  Specifically, a concern was expressed to CMS about difficulties encountered by such employers with regard to determination of Medicare beneficiary [...]

Medicare Set-Aside Arrangements (MSA) and the reporting requirements of Section 111 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (MMSEA) are important elements of the Medicare Secondary Payer Statute as the Centers for Medicare and Medicaid Services (CMS) endeavors to achieve the long-term financial viability of the Medicare system.  CMS has required MSA for [...]

An insured might on occasion elect to resolve a matter via internal financial resources without calling upon applicable insurance coverage.  If the “…settlement, judgement, award, or other payment…” involves a Medicare beneficiary, there are MMSEA Section 111 obligations that must be fulfilled as if the insurer were involved.    However, inasmuch as the insurer is [...]

The educational materials provided by CMS via the Computer Based Training (CBT) module for Direct Data Entry (DDE) protocol are most helpful, clear, and concise.  Given that the DDE reporting commences July 11, 2011, the materials provide an excellent overview.  In particular, specific and important information is provided vis-a-vis the calculation of the limitation of [...]

Legislation has been introduced in the U.S. House of Representatives pertaining to medical malpractice reform. The bill, H.R.5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (Introduced in House – IH) addresses several areas of proposed change. Perhaps of particular interest to those professionals providing Medicare Set-Aside (MSA) and structured settlement consulting resources, [...]

MMSEA Section 111 reporting is an element of the larger concept of Medicare Secondary Payer (MSP), which, simply put, establishes an obligation on entities and persons to protect Medicare’s interests in resolving claims in which medical specials are claimed or released. Efforts by defendants in personal injury claims to deflect this obligation via release language [...]

With the obligation to file MMSEA Section 111 reports on claims involving TPOC’s (Total Payment Obligation to the Claimant; i.e., settlements) now merely months away, we speculate as to the manner in which CMS will substantiate another delay in reporting if (when?) such a delay is announced, and what the implications might be as far [...]