Tag: ongoing responsibility for medicals

CMS Solicits Feedback on ORM Termination in Section 111 Reporting

June 1, 2026

cms orm termination and section 111 reporting compliance

In a May 26, 2026, letter to the stakeholder community, the Centers for Medicare and Medicaid Services (CMS) requested feedback on the voluntary termination of Ongoing Responsibility for Medicals (ORM), as it relates to Section 111 reporting.  Per the letter:

Currently, Chapter III, Section 6.3.2 – ORM Termination, provides various scenarios under which an RRE may terminate their ORM status when such status appropriately ends. DMPO desires industry feedback on whether the current parameters are appropriate, reasonable, and sufficient.

DMPO requests that any person or entity desiring to share feedback, ideas, concerns, or questions do so no later than June 9, 2026. Feedback need not be in any formal format or follow any particular parameters. DMPO is unable to guarantee a direct response to all feedback but will take all submissions into consideration as the policy around ORM termination is reviewed. Comments received after the above date will still be considered for future enhancements.

All submissions should be e-mailed to the new DMPO-managed mailbox relating to all Coordination of Benefits and Recovery (COB&R) inquiries:

COBR@cms.hhs.gov

ORM termination is critical not only to ending a payer’s responsibility for payment of injury-related medical care but also to allowing the injured claimant to access medical benefits for injury-related care. Even when care is not injury-related, an open ORM can still result in Medicare denying payment for medical care based on the false assumption that the treatment is related to the injury.

Tower MSA Partners will provide feedback to CMS. We encourage our client partners to share their feedback or reach out to us so we can relay your comments and concerns to CMS. Please contact Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com.

CMS Changes Rules for ORM and NOINJ Reporting in the Latest Update of its Section 111 Reporting User Guide

June 9, 2023

Tower MSA Partners explains CMS updates to ORM and NOINJ rules in the Section 111 reporting user guide.

The Centers for Medicare and Medicaid Services (CMS) recently released Version 7.2 of its MMSEA Section 111 User Guide. The guide contains some notable updates for Ongoing Responsibility for Medicals (ORM) reporting, determination of the ORM termination date with a physician letter, and use of the NOINJ code in certain liability settlements.

Revised Trigger for ORM Reporting

CMS revised Section 6.3 (Policy Guidance) on the trigger for reporting Ongoing Responsibility for Medicals (ORM):

The trigger for reporting ORM is the assumption of ORM by the RRE, which is when the RRE has made a determination to assume responsibility for ORM and when the beneficiary receives medical treatment related to the injury or illness. Medical payments do not actually have to be paid, nor does a claim need to be submitted, for ORM reporting to be required. The effective date for ORM is the DOI, regardless of when the beneficiary receives the first medical treatment or when ORM is reported.

We surmise that CMS added the additional requirement (bolded) for reporting ORM so that allow no-fault plans do not have to report ORM on minor claims that have no evidence of medical treatment.  Workers’ compensation plans already have an exclusion for reporting ORM on minor medical-only WC claims where medical payments do not exceed $750, along with other requirements (See Section 6.3.1 of the guide).

The change raises an interesting question: What obligation does the no-fault plan have to determine if treatment has occurred?  In other words, does the no-fault plan have to actively inquire about treatment? Or can it be passive and wait to report ORM after treatment is occurring? There isn’t an answer from CMS’s ORM definition.

Determining ORM Termination Date Based on Physician Statement

CMS previously added a provision to Section 6.3.2 (Policy Guidance) which allows ORM termination based on a physician statement finding that no additional medical items and/or services associated with the claimed injuries will be required.  Apparently, a question arose about what ORM termination date to enter if such a physician letter is obtained.  Per CMS:

Where an RRE is relying upon a physician’s statement to terminate ORM, the ORM termination

date to be submitted should be determined as follows:

  • Where the physician’s statement specifies a date as to when no further treatment was

required, that date should be the reported ORM termination date;

  •  Where the physician’s statement does not specify a date when no further treatment was

required, the date of the statement should be the reported ORM termination date;

  •  Where the physician’s statement does not specify a date when no further treatment was

required, nor is the statement dated, the last date of the related treatment should be used as the ORM termination date.

The above should clarify the appropriate ORM termination date to use when a physician statement is obtained.

Reporting of NOINJ is Now Optional

Since the early days of Section 111 reporting CMS has required liability claims where medicals are released in settlement but where the type of claim typically has no associated or alleged medical care to be reported.  Because there were no diagnosis codes to report, these claims were reported with a “NOINJ” code.  Examples of such claims were loss of consortium, an errors or omissions liability insurance claim, a directors and officers liability insurance claim, or a claim resulting from a wrongful action related to employment status action.

CMS has now revised its policy in Section 6.2.5.2 of the User Guide (Technical Information) on the reporting of such claims to state:

Note: In cases where the reporting of a liability record only meets the criteria for reporting a ‘NOINJ’ diagnosis code in Field 18, the reporting of the record is no longer required. However, it is optional for the RRE to report the record with the ‘NOINJ’ diagnosis code following the previously existing rules in the User Guide as follows:

This update is great news for carriers who have had to report these types of claims for more than a decade now.

If you have any questions on these updates, please contact Tower’s Chief Compliance Officer, Dan Anders, at (888) 331.4941 or daniel.anders@towermsa.com