Medicare Secondary Payer Mandatory Reporting

Provisions in Section 111 of the MMSEA

CMS Update: August 6, 2009

Periodic Worker's Compensation Payments

CMS has published an update to address whether periodic worker's compensation payments must be considered when determining the Total Payment of Compensation (TPOC) thresholds for reporting purposes under the MMSEA. This update says:

"In situations where the applicable worker's compensation law or plan requires the RRE to make regularly scheduled periodic payments to, or on behalf of, claimant and the applicable worker's compensation law or plan specifically precludes these periodic payments from including any direct or indirect payment for past, present, or future medical expenses; the RRE does not report these periodic payments (they are not reportable as either TPOC or ORM). Otherwise, these payments are considered to be part of and are reported as ORM."

What Does That Mean To You?

Ind. Code § 22-3-3-10(i) provides that TTD and PPI payments shall be paid in weekly amounts. So, in Indiana, reportable TPOC would only be the settlement amount which is over and above the PPI amount. (There is no need to report TTD, PPI, or any compensation payments as TPOC.)

We predict that CMS will not accept your allocation of payments in settlement agreements and will inquire if it feels there is additional TPOC that has not been reported. You may want to make notation of Ind. Code § 22-3-3-10(i) in the "other" section on the proposed ORM termination sheet in the handout we gave you so that you can easily explain these provisions of the Indiana Worker's Compensation Act to CMS, should they question payments made related to your claims.

We will continue to keep you updated as CMS publishes additional guidelines and clarifications. If you have questions about the MMSEA process, you can contact Ann Stewart of Ice Miller LLP.

This publication is intended for general information purposes only and does not and is not intended to constitute legal advice.  The reader must consult with legal counsel to determine how laws or decisions discussed herein apply to the reader's specific circumstances.