
Medicare secondary payer policy and procedures regarding ORM
October 27, 2015Effective October 1, 2015, Medicare processing systems will be updated to automate the fact that an ongoing responsibility for medicals (ORM) responsibility (associated with specified medical conditions) is assumed, exists, or did exist for a particular time period. This information will be noted on the Medicare secondary payer detail (MSPD) screen. When claims are processed, Medicare will compare the diagnosis code(s) on the claim with the diagnosis code(s) associated with the ORM record. Claims will be denied where the ORM indicator is present for the period covered by the claim and the diagnosis code(s) match(es) (or match(ed)) within the family of diagnosis codes.