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Medicare Requirements and Worker’s Compensation: Year-End Update Medicare Requirements and Worker’s Compensation: Year-End Update

Medicare Requirements and Worker’s Compensation: Year-End Update

Federal law requires that parties consider Medicare’s potential interest when settling a worker’s compensation claim with a Medicare beneficiary. The employer or insurer may also need to report this settlement to CMS (Center for Medicaid and Medicare Services) as part of its mandatory reporting requirement under Section 111 of Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007. Identifying all conditional payments (a reimbursement request for medical care CMS paid that it asserts is related to the settled claim and another parties’ responsibility) and allocating responsibility for payment before finalizing settlements will help avoid surprises and additional exposures. Implementation of a new law should help the parties evaluate whether CMS has a conditional payment interest.  

The PAID Act

The Provide Accurate Information Directly (PAID) Act became effective on December 11, 2021. The PAID Act requires CMS to provide more information about Medicare beneficiaries in response to inquiries from Non-Group Health Plan (NGHP) Responsible Reporting Entities (RRE). Implementation of this new law will allow insurers and employers to obtain additional, and more accurate, information related to potential conditional payment requests.  

Additional Useful Information:

Reporting Thresholds Remain the Same

CMS will maintain the current $750 reporting threshold for 2022 for physical trauma-based liability, no-fault and worker’s compensation settlements for cases with no ongoing responsibility for medical care (ORM). This means that settlements of $750 or less do not need to be reported and Medicare’s conditional payments amount do not need to be repaid.

ORM Termination Dates

A useful change to Section 111 reporting data is that responsible reporting entities (RRE) can now input ORM termination dates years in the future. Therefore, an RRE can populate this field now with a date two years in the future to correspond with the two-year statutory limitation date. The ORM date can be adjusted as needed.

What’s Next?

We can expect CMS to continue its policy and technology updates and its collection efforts.  We may see civil penalties related to Section 111 reporting in 2022. Therefore, we recommend you review your current reporting process to make sure the reports are accurate, complete and timely.  

For more information about worker's compensation or Medicare requirements, contact Ann H. Stewart.

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