New Medicare Reporting Act Requires Employer Cooperation
By Sarita Shipe
In the June 2009 edition of News & Views, we informed you about the upcoming implementation of the new Medicare, Medicaid & SCHIP Extension Act (MMSEA). This legislation is intended to ensure that Medicare does not pay for a beneficiary's care when another insurer has primary responsibility. Besides group health plans, other insurers now include carriers that provide liability, no-fault, and workers’ compensation. Carriers who provide these coverages must now identify the Medicare beneficiary status of claimants, and report claim data to Centers for Medicare & Medicaid Services (CMS) on a quarterly basis.
Organizations subject to the MMSEA are called Responsible Reporting Entities (RREs). The TASB Risk Management Fund is the RRE for claims reported to us by our members. We will use the CMS Medicare eligibility program to determine each claimant’s beneficiary status, and will report any eligible claims to CMS on a quarterly basis.
Potential Medicare recipients fall into three categories:
- Individuals age 65 years or older
- Certain disabled persons (identified by specific diagnosis codes)
- Individuals with permanent kidney failure
In order to identify potential Medicare recipients, the Fund will likely be modifying the initial 3-point interview to include questions on whether the injured worker is receiving or has applied for Medicare. If they are a beneficiary, we will ask for their Medicare health insurance claim number (HICN). In addition, an effort will be made to verify with the claimant that the social security number provided on the First Report of Injury is correct.
The claim reporting process began January 1, 2010. We are now required to submit personal information, diagnosis, claim payments, notice of settlements, judgments, or awards where the injured party is a Medicare beneficiary. While the burden to you in this process is minimal, we would like to stress the importance of gaining valid social security data from employees in this national effort to improve the accountability of the Medicare system. This process is new to everyone, and, undoubtedly, changes will be made as time goes on. We will continue to keep you informed and answer any questions that you may have. For more information, contact Sarita Shipe at 800.482.7276, ext. 7221.
