Medicare Secondary Payer Mandatory Reporting Provisions
Section 111 MMSEA
New User Guide, Alerts and Dates, Oh My!
In a previous alert, we reported that the Centers for Medicare and Medicaid Service (CMS) delayed the date that self-insured employers and insurance companies must begin reporting information related to claims with Medicare beneficiaries until the first quarter of 2011. This postponement of the Section 111 reporting requirements has prompted a couple more changes that are important to many of you:
- The claims to be included in the initial production only need to include claims with Ongoing Responsibility for Medical care (ORM) dates of January 1, 2010 (rather than July 1, 2009), and after.
- If the claim is open January 1, 2010, regardless of when ORM is assumed, it should be reported.
- If the claim is closed prior to January 1, 2010, there is no need to include it in the original report. If a closed claim with ORM is reopened after January 1, 2010, it must be reported then.
- There is no longer a requirement to "look back" to claims with ORM dates between January 1, 2009, and July 1, 2009. The "special reporting extension" found in section 11.9 of the user guide, version 2.0, will be eliminated.
- Total Payment of Compensation (TPOC) settlements are not required to be reported unless the settlement has a date of October 1, 2010, and after (versus January 1, 2010).
- The threshold levels for reporting TPOC have not changed and the language in the user guide has been corrected to reflect that these reporting levels are "less than or equal to" the amount listed.
- It is important to look to at the language in the user guide to determine how the TPOC date is defined and apply it to your situation.
If you have any additional questions about CMS' latest update, please contact Ann Stewart. We will continue to keep you informed regarding additional CMS guidelines and clarifications.
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. |
