Western Litigation, Inc. (WLI) performs all state, federal and National Practitioner Data Bank (NPDB) reporting to alleviate the burden for you, allowing you to focus on your daily operations.
MMSEA Section 111 Reporting
As various self-insured healthcare organizations come to terms with the meaning of Medicare’s Section 111 reporting requirements, WLI has been integrating the reporting requirements with its professional and general claims management procedures to provide a complete turn-key solution for its clients. WLI is pleased to announce the completion of its unique business intelligence reporting tool with full Medicare Section 111 compliance capabilities.
WLI’s processes and technology provides you with the necessary tools to ensure your compliance with the MMSEA Section 111 reporting. WLI has also updated its claim handling procedures to perform all of the required data collection necessary for monthly beneficiary queries to the Social Security Administration. WLI’s professional and general liability claims and risk management information system (RMIS) database, Genesis, has been enhanced to allow it to transmit quarterly RRE reports directly to Medicare via its secure reporting protocol methodology.
Specifically, WLI’s processes and procedures are designed to minimize your reporting exposure and provide:- Effective and consistent methods for determining the Medicare eligibility of claimants
- Clear visibility into the CMS reporting status
WLI’s MMSEA reporting services also include:
- Assistance with RRE registration with CMS
- Testing of each RRE’s monthly beneficiary queries to the Social Security Administration’s website
- Testing of each RRE’s data file transmission and upload to CMS’ secure site
- Assimilation of claims data and additional data required under the CMS reporting requirements
- Production report information gathering and submission in accordance with each of our client’s RRE assigned reporting schedule
- Genesis online access to Medicare audit reports
WLI’s Medicare reporting represents complex processes driven by complex technology. WLI manages the entire MMSEA reporting process for its clients, allowing them to focus on their core business operations.
National Practitioner Data Bank (NPDB)
The legislation that led to the creation of the National Practitioner Data Bank (NPDB) was enacted because the U.S. Congress believed that the increasing occurrence of medical malpractice litigation and the need to improve the quality of medical care had become nationwide problems that warranted greater efforts than any individual State could undertake.
The intent is to improve the quality of healthcare by encouraging State licensing boards, hospitals and other healthcare entities and professional societies to identify and discipline those who engage in unprofessional behavior; and to restrict the ability of incompetent physicians, dentists and other healthcare practitioners to move from State to State without disclosure or discovery of previous medical malpractice payment and adverse action history. Adverse actions can involve licensure, clinical privileges, professional society membership and exclusions from Medicare and Medicaid.
The NPDB is primarily an alert or flagging system intended to facilitate a comprehensive review of healthcare practitioners' professional credentials. The information contained in the NPDB is intended to direct discrete inquiry into, and scrutiny of, specific areas of a practitioner's licensure, professional society memberships, medical malpractice payment history and record of clinical privileges. The information contained in the NPDB should be considered together with other relevant data in evaluating a practitioner's credentials; it is intended to augment, not replace, traditional forms of credentials review.
