New Info on Medicare Set Asides from CMS

Sunday, May 22, 2005 | 0

In a continuing effort to help keep you up-to-date on happenings in Medicare, Gould & Lamb, LLC, a medical-financial services company, offers the following summary of some important and timely information related to Medicare set-asides:

Sample Submission Documents & New COBC Fax Line In order to help the WC Industry understand Medicare Set-Aside submission requirements, the Centers for Medicare and Medicaid Services has posted a sample submission on their website. In that 80% of all cases submitted are rejected at the COBC level, it is important to understand their requirements.

The web address for the sample submission is:

http://www.cms.hhs.gov/medicare/cob/pdf/attwc_sample.pdf

This document was prepared in response to the numerous inadequate submissions being received by the Coordination of Benefits Center (COBC) in New York. Gould & Lamb currently provides CMS compliant submissions, but this sample submission document posted on the preceding website does outline the types of supporting data and minimum requirements for CMS submission. CMS has noted that this is intended to be used as a sample and that the more information the submitter provides, the quicker the proposal can be reviewed.

Additionally, CMS has added a new dedicated fax line at the COBC for additional documentation on a previously submitted case or when there is a request for additional documentation to the submitter. The new fax number is (646) 458-6745. CMS has requested that submitters observe the following rules:

1. There is a maximum of 10 pages per fax
2. Never submit the original documents
3. Do not mail and fax the same documents
4. Always show the CCN (case control number) on each page of the fax document

Net Result: CMS continues to take positive administrative steps to improve the effectiveness and efficiency of the MSA approval process.

If you have any questions concerning the information contained in this bulletin or would like source and/or reference material please contact us at news@gouldandlamb.com or call 866-672-3453 ext.1332.



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