Medicare Updates That Impact Employer Reporting Requirements Medicare Updates That Impact Employer Reporting Requirements

Medicare Updates That Impact Employer Reporting Requirements

2017 TPOC Reporting Threshold

In December 2016, the Centers for Medicare and Medicare Services (CMS) announced that it was reducing the recovery threshold for physical trauma-based liability settlements from $1,000 to $750. CMS also announced that it will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medical care.

Therefore, effective January 1, 2017, if the most recent liability settlement (Total Payment Obligation to the Claimant, or TPOC) is on or after January 1, 2017 and the cumulative TPOC amount is greater than $750, the settlement must be reported.

New Medicare Identifiers Will Be Issued In 2018

On January 17, 2017, CMS communicated proposed changes it is making under the Social Security Number Removal Initiative (SSNRI). Next year, from April 1, 2018 through December 31, 2019, CMS will begin issuing Medicare Beneficiary Identifiers (MBI) to replace the Social Security Number (SSN) based Health Insurance Claim Number (HICN) currently in use. The SSNRI includes an exception for all Medicare Secondary Payer data exchanges and processes used for Section 111 reporting. Social Security Numbers (SSN) will still be permitted on all correspondence with CMS and on Section 111 Queries and Claim reporting. Database fields that reference ‘Health Insurance Claim Number’ will be updated to reflect ‘Medicare Identifier.’

CMS estimates that 150 million Americans, both active beneficiaries as well as deceased and archived beneficiaries, will be assigned MBI numbers during the roll out. As MBIs are assigned, on or after April 2018, MBIs will be used in response files from CMS and be populated in the existing HICN fields.
What does this mean to our clients?

  1. Self-insured employers and insurers with ongoing responsibility for medical care to Medicare beneficiaries should determine how to update records once new MBIs are assigned. CMS will notify Medicare beneficiaries, but there does not appear to be an obligation to notify the responsible reporting entity. Therefore, we encourage our clients to identify the Section 111 claims that may be impacted and develop a system to update the HICN to an MBI, the Medicare Identifier.
  2. For all settlements with Medicare beneficiaries that have the impact of releasing medical care issues, employers and/or insurers should request the MBI to use when reporting the settlement to CMS or determining its potential reimbursement interests based on conditional payments.
  3. For Non Group Health Plan (NGHP) entities, we recommend you evaluate your system to determine whether there needs to be an update in order to accept the new 11-character MBI values.
For more information on Medicare Services, contact Ann Stewart or a member of our Worker's Compensation practice group.

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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