New Medicare Reporting Requirements on the Horizon
by Sarah Holguin and Paul Taylor
Claims adjusting, reporting, deadlines, and many other administrative duties can be arduous daily tasks for TASB staff and Fund members. This year, new Medicare reporting requirements will go into effect. If you are looking to gain a better understanding of these requirements imposed on all insurance carriers and related entities, we can help! This article will provide a brief synopsis of the law and an overview of the requirements.
In 2007, the Medicare Secondary Payer Mandatory Reporting Provisions (MSP) were added to Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA). The new reporting provisions attempt to avoid duplicate payments for items and services furnished to Medicare beneficiaries.
The new Section 111 reporting requirements for liability insurance, no-fault insurance, and workers’ compensation have two phases: (1) registration and (2) reporting. The registration process must take place between May 1 and September 30, 2009. The Medicare Secondary Payer claim input required testing process begins January 1, 2010 and the Medicare Secondary Payer claim reporting process begins April 1, 2010. The claim reporting requires entities to submit personal information as well as notice of settlements, judgements, or awards on claims where the injured party is a Medicare beneficiary.
The Medicare Secondary Payer provisions also:
- define who must report
- specify how and when reporting must be done
- include significant penalties for noncompliance
Risk Management Fund pool members and their staffs will have a limited role regarding the new requirements. TASB staff, who will handle most required duties, are now working hard to make necessary workflow adjustments and establish electronic data transfer capability with the Federal agency responsible for implementing the reporting requirements.
Risk Management Fund members should be aware, however, that their district may have reporting responsibilities for open claims continuing through a previous carrier or third party administrator. Be proactive and contact previous carriers to determine if these new requirements will apply to any remaining open claims and also to determine who will be responsible for reporting these claims.
While there are still questions to be answered and rules to be defined in this effort to improve the accountability of the Medicare system, TASB staff will actively monitor developments and provide updates as the reporting requirements unfold and are clarified. For more information, see the agency Web Site concerning these requirements, or contact June Kissinger or Paul Taylor at 800.482.7276, ext 3545 or ext 3663, respectively.
