New Mandatory Reporting Requirements in Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“Section 111”) adds new mandatory reporting requirements for group health plan arrangements and for Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers’ Compensation (“NGHP”).  The purpose of the reporting requirements is to better enable the Centers for Medicare and Medicaid Services (“CMS”) to coordinate benefits under the Medicare Secondary Payer Act, by identifying primary payers responsible for the medical benefits available to a Medicare beneficiary, and to prevent the mistaken or unnecessary conditional payment of such benefits by Medicare. 

Entities responsible for complying with Section 111 are referred to as “Responsible Reporting Entities” or “RREs.”  In addition to statutory definitions provided by Section 111, CMS-issued guidance should be consulted in determining if an entity is an RRE.  Generally, an NGHP RRE is an “applicable plan,” meaning, for relevant purposes, an insurer.

Highlights of Section 111 implementation include the following:

• RREs are required to register with CMS’ Coordination of Benefits Contractor (“COBC”) and to fully test the data submission process before submitting production Claim Input Files.
• The submission of production Claim Input Files generally begins in the first calendar quarter of 2011, according to an assigned submission timeframe for each RRE.
• By this point, all RREs who must report claims beginning in early 2011 should be registered and testing files (or finished testing), in preparation for the submission of production files.
• CMS recently issued an Alert, extending by one year — until January 1, 2012 — the reporting of liability TPOC claims ONLY, with no Ongoing Responsibility for Medicals (“ORM”) involvement.
• CMS is now offering a Direct Data Entry (“DDE”) option for “Small Reporters” to manually input file submissions via a website portal.

An RRE that fails to comply with Section 111’s reporting requirements may be subject to a civil penalty of $1,000 for each day of noncompliance with respect to each claimant.  If your company appears to be an RRE that has not yet made arrangements for the required reporting, or if you are not sure if your company is required to report under Section 111, we encourage you to contact our office for further information.

This information is intended to provide a general overview of the issues contained herein and is not intended, nor should it be construed, to provide specific legal or regulatory guidance or advice.  If you have any questions or issues of a specific nature you should consult with appropriate legal or regulatory counsel to review the specific circumstances involved.

Should you have any questions or comments, please contact Colodny Fass.

To unsubscribe from this newsletter, please send an email to bellis@cftlaw.com.