Lisa Shortt recognized an oncoming challenge for her clients when she learned about the new reporting requirements being imposed pursuant to Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). These reporting requirements, which take effect on January 1, 2011, impose a significant burden on all self–insured entities, liability insurers, No-Fault insurers, and Workers’ Compensation insurers to report payments made on behalf of or to Medicare beneficiaries.
Lisa created a database-driven software solution that makes compliance with Section 111 simple. Thus, S.1.M.P.L.E. (Section 111 Medical Payments by Liability Entities) Reporting Software was born of Lisa’s combination of technical acuity and legal experience.
To comply with this new law, information regarding any settlements, judgments, or awards that are made on or after October 1, 2010, or any acceptance of medical payment responsibility on or after January 1, 2010, on behalf of a Medicare beneficiary must be reported in a very specific form and format. The potential for entering the data in a non-compliant manner is significant. In fact, the file that CMS (Centers for Medicare and Medicaid Services) returns in response to a misfiling has space for 10 out of more than 200 error codes to identify what has been done wrong in the report. Each of these types of errors results in the record being rejected.
S.1.M.P.L.E. Reporting Software drives proper data entry by restricting field inputs, identifying errors with error reports, formatting fields to the required specifications, and automatically creating the reports specified by Medicare. It also imports Medicare’s Response file and generates a report.
Equally important is the fact that this fully portable software allows users to have possession and control of their data. Lisa knew it would be important to allow reporting entities to decide if they want to report directly to Medicare or assign their reporting responsibilities to an agent.
Anticipating the needs of reporting entities came naturally for Lisa, in large part due to her work assisting clients in responding to and/or challenging Department of Justice and intermediary audits into Medicare and Medicaid billing. When she isn’t inventing new software, Lisa also assists her clients in handling Medicare billing issues and challenges.
In the realm of Medicare and regulatory compliance, it is refreshing to hear that there is an advocate for practical, simple solutions to the ever-evolving, increasingly complex Medicare reporting requirements.
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