Background Regarding ORM for A/B MACs and DME MACs

20.4.1 - Background Regarding ORM for A/B MACs and DME MACs (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) Pursuant to Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007, “applicable plans” (liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans) are required to report settlements, judgments, awards, or other payments involving individuals who are or were Medicare beneficiaries to the Centers for Medicare & Medicaid Services (CMS). The applicable plan is the “Responsible Reporting Entity” (RRE) for this process. The required reporting includes instances where the RRE has assumed ongoing responsibility for medicals (ORM) associated with specified medical conditions. This information is collected to determine primary claims payment responsibility. Examples of ORM include, but are not limited to, a no-fault insurer agreeing to pay medical bills submitted to it until the policy in question is exhausted, or a workers’ compensation plan being required under a particular state law to pay associated medical costs until there is a formal decision on a pending workers’ compensation claim. The RRE may assume ORM for one or more alleged injuries/illnesses without assuming ORM for all alleged injuries/illnesses in an individual’s liability insurance (including self-insurance), no-fault insurance, or workers’ compensation claim. For example, if an individual is alleging both a broken leg and a back injury, the RRE might assume responsibility for the broken leg but continue to dispute the alleged back injury. When ORM ends (for example, a policy limit is reached or a settlement occurs which terminates the RRE responsibility to pay on an ongoing basis), the RRE reports an ORM Termination Date to the MSP Contractor via an ECRS request, and this information is uploaded to Common Working File (CWF) by the MSP Contractor. NOTE: A Section 111 ORM report is not a guarantee that medicals will be paid indefinitely or through a particular date.