Registration for Medicare Mandatory Reporting

Begins May 1, 2009 – Are You Ready?

Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) adds more teeth to the Medicare Secondary Payer Statute. It now requires self-insured employers to report certain information to Medicare. Providers of group health plans, liability insurance (including self-insurance), no-fault insurance and insured and self-insured worker's compensation programs must determine whether benefits are being paid to Medicare recipients and, if so, report information to the Center of Medicare and Medicaid Services (CMS). The group health plan provisions are now in progress. Registration for the liability, no-fault and worker's compensation programs begin on May 1, 2009.

For many years, Medicare has been, by law, "secondary" to other types of insurance and benefit plans (insured or self-insured). This legislation increases Medicare's surveillance of these primary payers and requires companies to report any worker's compensation claims they have if the injured worker is a Medicare beneficiary. These amendments do not eliminate any existing statutory provisions or regulations related to Medicare beneficiaries, but add additional reporting requirements, with substantial penalties for compliance failures.

What do I do now?

Registration for providers of liability, no-fault and worker's compensation programs begins May 1, 2009. At that point, any carrier or self-insured employer who is responsible for worker's compensation or medical benefits to a Medicare beneficiary is required to register to begin the process of data exchange with Medicare. If a company doesn't have any claims involving a Medicare recipient as of July 1, 2009, there is no need to register. As soon as a company gets such a claim, however, they should start the registration process.

The reporting aspect of this program may begin in October 2009. During the last quarter of 2009, each responsible reporting entity (RRE) is expected to submit the information related to its obligation (as of July 1, 2009) and continue to submit new claims quarterly. It is important for a company to determine if they are a RRE under the amended legislation and begin the registration process now. Companies should also review any claims they have settled between January 1, 2009 and July 1, 2009 to determine whether the claims involved a Medicare recipient. There may be additional reporting requirement on these claims.

It is important to comply with Medicare's requirements but equally important not to overlook state law requirements relating to worker's compensation. If companies don't manage the reporting program carefully, they may be exposing themselves to larger liability than needed under state law. If a company does business in several states, they will want to design their reporting program so that they can take advantage of each state's laws.

Is there more to come?

We expect to see further guidance from CMS as it implements its mandatory reporting systems for providers of group health plans, liability (including self-insurance), no-fault and worker's compensation programs. Business leaders may have a lot of questions that may include:

· Is this something I really need to do?

· What do I do in order to comply?

· We are a third party administrator, what do we need to be telling our clients?

· My parent company is taking care of this. Is there anything I need to worry about here in Indiana?

· What are the deadlines?

Ice Miller will continue to monitor developments and evaluate their implications under Indiana law. There are steps companies should be taking right now as they develop a reporting process to limit exposure for future Medicare liability and pay only what they are legally obligated to pay. If you would like to talk about these issues or feel you need further guidance in order to comply prudently, please contact Ann Stewart.

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.