Section 111 Reporting for COVID-19 Claims

CMS has updated the list of valid diagnosis codes for Section 111 reporting to include the new ICD-10 code for COVID-19 (U071). If a Responsible Reporting Entity (RRE) has assumed or is required to assume responsibility for payment of COVID-19 related medical expenses for a Medicare beneficiary on an ongoing basis, Ongoing Responsibility for Medicals (ORM) should be reported under Section 111 with this code. As a reminder, the trigger for reporting ORM is when the RRE has assumed or is required to assume responsibility for payment, not when the RRE first issues payment. For a COVID-19 claim involving a Medicare beneficiary, a settlement, judgment, award, or other payment on behalf of the claimant should be reported as a Total Payment Obligation to the Claimant (TPOC). Any conditional payment claims should be resolved as well. The list of valid ICD-10 codes for Section 111 reporting is available in the Reference Materials section at https://www.cob.cms.hhs.gov/Section111/.