Medicare Secondary Payer Rules: Impact of Section 111 reporting requirements

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Rebecca Price, claims manager Medicare Secondary Payer Rules: Impact of Section 111 reporting requirements
Presented by Premier Insurance Management Services, Inc.
,MMSEA Section 111 Timeline-2009 May 1 to June 30: Registration is now open for all potential RREs with CMS secure Web site (COBSW)
July 1: CMS reporting is triggered for settlements, judgments, and awards made after this date July 1 to December 31, 2009: Testing data transmissions from RREs/Agents January 1, 2010: Reporting to CMS begins Reporting will be quarterly, during a 7 day reporting schedule to be assigned to RRE by CMS
,Background:Section 111 Mandatory Medicare Secondary Payer Reporting Section 111 of the MMSEArequires certain "responsible reporting entities" (RREs) to register online between May 1st and June 30, 2009 and to report quarterly to CMS, in a new electronic format, any settlement, judgment, award or other payment made on or after July 1, 2009 which compensates an injured Medicare beneficiary (MB) for personal injury.Penalties for not reporting are $1,000 per day per claim.
,Background:Sec. 111 Mandatory Medicare Secondary Payer Reporting The MMSEA broadly defines an RRE, and can be paraphrased from the current version of the CMS User’s Guide as “any entity which issues a check over $5,000 to compromise a liability claim/lawsuit brought by an injured MB.”  This includes self-insured entities and those that pay the plaintiff directly within a deductible or self-insured retention program.  Because of the burdensome IT requirements, and large potential fines, this definition could create many problems for hospitals and other business entities that may not even be aware of the new reporting requirement.
,CMS Section 111 broadly defines an RRE These payments to a Medicare Beneficiary would require the individual or entity to register as an RRE to report the payment and then report quarterly forever…
A small store owner with a $25,000 GL deductible pays $15,000 to a customer who incurred an injury in a fall at his store even though owner is later reimbursed by his insurance company
A rural clinic with a $100,000 self-insured deductible pays $8300 to a patient for medical care from another provider due to alleged malpractice Payment amount requiring a report decreases- reporting duty increases 7/1/09 – 12/31/10: ≤ $5,000
1/1/11 – 12/31/11: ≤ $2,000 1/1/12 – 12/31/12: ≤ $600 Once an RRE is registered, CMS requires submission of an “empty file” every quarter even if there are no payments to report! {Once an RRE, always an RRE}
,RREs must understand the reporting requirements Download the CMS Liability Insurance User Guide and the subsequent alerts amending it on the CMS Web site:
Register on the CMS Web site to receive alerts when CMS makes changes to the User Guide or adds notices or resources to the site: Access the recorded PIMS Web conference "New CMS claim reporting requirements will hit insurers and self-insurers in 2009 (including hospitals and their captives): What you need to do now!” Provides critical information hospitals need to consider as they work to comply with the CMS regulations for reporting liability payments.
,CMS comment portal Submit comments to CMS urging that the rule be amended: Apply only to insurers and entities that are fully self-insured and are experienced with mandatory reporting compliance
Remove the IT burden by creating an internet-based input program to give CMS claims information directly or some other type of manual reporting system for those expecting to make few reports. Eliminate the quarterly “empty” Claim Input File reporting requirement so that entities

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