Summer 2009 SBH Work Comp Quarterly
Oregon Workers' Compensation
PDF FormatMedicare Secondary Payer Mandatory Reporting
By Jeana Wines
You should be aware Medicare has new mandatory reporting requirements concerning liability insurance (including self-insurance), no-fault insurance and workers’ compensation. Penalties for non-compliance are stiff at $1,000 per day! You must take steps to address these changes now. This summary is not exhaustive, but will assist you in understanding these changes and provide you with resources to get started.
Who: The new provisions affect “Responsible Reporting Entities” (RRE), which includes the fiduciary or administrator of laws and plans for:
- Liability insurance (including self-insurance);
- No fault insurance; and
- Workers’ compensation.
What: RREs must report the identity of a Medicare beneficiary whose illness, injury, incident or accident is at issue. In other words, if you have a claimant who is or may become a Medicare beneficiary, you must report that claimant’s identity to Medicare.
Why: Medicare does not want to pay for medical services if they do not have to. If your claimant is a Medicare beneficiary, Medicare wants billing for claim-related services to go directly to the claim administrator.
How:
- An RRE should designate a person to report the requested data on behalf of the RRE.
- That person needs to register the RRE on a secure website that will be used to transmit the data.
- Once the RRE’s registration is complete, the CMS Coordinator of Benefits Contractor (COBC) will begin working with the RRE to set up the data reporting and response processes. Tech support should also be designated to assist through this process.
When: Register electronically 05/01/09 – 09/30/09. A testing period will follow registration. Each RRE will be assigned a quarterly reporting schedule.
Notes:
- Your reporting responsibility continues as long as you may be responsible for medical services for an individual. You need to have a system for continually determining claimant Medicare eligibility.
- Reporting also seems appropriate when an RRE enters a settlement agreement that contemplates future medical expenses.
- The RRE’s responsibility for reporting cannot be shifted to the claimant. The website will have a query screen where you can determine your claimant’s Medicare status. If claimant provides you (the RRE) with an incorrect Social Security number, if there is a transcription error, if you were simply unaware claimant became eligible for Medicare, you will be subject to penalties of $1,000 per day!
More Information:
- Register now: www.section111.cms.hhs.gov/MRA.
- Read the detailed User Guide and May 11, 2009 supplement.
- Alerts and more detailed information will be posted periodically, and you can sign up to receive alerts by email: www.cms.hhs.gov/mandatoryinsrep.
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