Medicare Secondary Payer Mandatory Reporting
Provisions
Section 111 MMSEA
CMS UPDATE: February 18, 2010
Section 111 Reporting
Requirement POSTPONED to January 1, 2011
The Centers for Medicare and Medicaid Service (CMS) announced that it has delayed the first production date for non-group health plan (NGHP) input files from April 1, 2010, to January 1, 2011. All NGHP file data exchange testing should continue and be completed by December 31, 2010, so that the responsible reporting entity (RRE) can produce the necessary information on January 1, 2011.
This means you do NOT need to report your worker's compensation and personal injury settlements to CMS until next year. This does not appear to change the claims you will have to report; i.e., settlement of cases involving Medicare recipients which were settled on or after January 1, 2009 (depending on thresholds and ongoing responsibility for medical – ORM).
CMS also announced that it will publish the next version of the Section 111 NGHP User Guide the week of February 22, 2010. CMS also intends to publish a number of alerts relating to particular NGHP policy issues. In addition, it appears that CMS plans to post an alert describing the steps that NGHPs and RREs can take to assure their ongoing compliance with the Section 111 reporting requirements. Ice Miller attorneys will review alerts closely to determine whether there are changes to the substance of the reporting.
While this delay may be welcome, it is important to continue gathering data related to claims that involve Medicare beneficiaries. The reporting data change does not impact your obligation to identify conditional payments and to consider Medicare's interests in settlements with Medicare beneficiaries.
If you have any questions regarding the new Medicare reporting requirements or the ongoing requirement to identify conditional payments, please contact Ann Stewart. We will continue to keep you informed regarding additional CMS guidelines and clarifications.