Medicare Mandatory Reporting Requirements

Transcription

1 Medicare Mandatory Reporting Requirements Implementation of Medicare Secondary Payer Mandatory Reporting Provisions in Sect. 111 of the Medicare, Medicaid & SCHIP Extension Act of 2007

2 Legislative History Medicare, Medicaid & SCHIP Extension Act of S (now Public Law No: ) Introduced on 12/18/2007 Passed in US Senate by unanimous consent on 12/18/2007 Passed in US House by vote on 12/19/2007 No advance notice or opportunity for input given to liability insurers 2

3 What does the law say? All liability insurers must determine if a claimant is Medicare beneficiary If a payment of any kind is made to a Medicare beneficiary (whether by settlement or award), a report of that payment must be made to CMS Report must include claimant s name and any other information requested by the Secretary of HHS Frequency of reports to be determined by the Sec. $1,000/day fine for failure to comply 3

4 How is implementation proceeding? CMS issued User Guide on March 16 th Information on registering, queries and reporting Listing of required data elements Will be updated as needed Ongoing conference calls with CMS Monthly/semi-monthly calls being held CMS officials provide latest information Remainder of time for questions 4

5 Info available at - 5

6 Guidance - Registering All liability insurers will have to register as reporting entities at Must provide name and address of entity, as well as TIN, NAIC company code, phone, fax, and parent/subsidiary name(s) Must provide info for authorized representative, account manager, estimated number of claims paid in prior year, intended method of data transmission (must be electronic), and if a reporting agent will be used Must register between 5/1/09 and 9/30/09 CMS contractors will help registrants with reporting process 6

7 Guidance - Reporting May query CMS to confirm Medicare beneficiary May report directly to CMS or via collection agent Use of collection agent will not exempt insurer from responsibility to comply with all aspects of the reporting requirement Must report all required data elements Safe harbors for info that cannot be collected being considered Awards/settlements below minimum threshold not reportable Testing period to run from 7/1/09 3/31/10 First official reports must be filed during second quarter of 2010 (for claims closed as of 1/1/10) Reports must be filed quarterly 7

8 Guidance Data Elements Required Injured party - Name, DOB, SSN/HICN, gender Claimant (if other than injured party) name, contact & SSN Insurance policy - type of policy, TIN & contact for insurer, policy & claim numbers Attorney for claimant name, contact info and SSN Incident - Date, nature and cause of injury (using ICD-9 code after 12/31/10), state where incident occurred Resolution - Settlement/award date, amount, claim resolution (on-going responsibility) 8

9 Long Term Concerns 42 CFR (i) Gives Medicare the right to collect from any primary payer (e.g. a liability insurer), if the payment recipient (claimant) fails to reimburse Medicare within 60 days of receiving the award/settlement Insurers could potentially pay medical benefits to the claimant and then be required to reimburse Medicare for the full costs of any Medicare benefits paid on behalf of the claimant in other words you pay twice for the same claim 9

10 What is PIAA Doing? Formed Medicare Reporting Task Force Participating in CMS calls Reviewing and analyzing CMS documenation Submitting questions to CMS Producing Frequently Asked Questions documents for Members Reviewing options for improving MSP recovery 10

11 What should PIAA companies do now? Must gear up for compliance Monitor forthcoming guidance Decide to report directly or through an agent Adjust claims software for new data fields Ensure account manager is knowledgeable in coding requirements Determine data transmission method Register with CMS Take CBT courses Establish policies for requiring claimants to assume responsibility for any/all reimbursements to Medicare 11

12 Questions? Mike Stinson Director of Government Relations Physician Insurers Association of America Direct: (240)