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By now, most self-insured entities, liability insurers and other primary payers have heard that there are new mandatory reporting obligations under Section 111 of the Medicare, Medicaid and S-CHIP Extension Act (MMSEA) and have been reminded about the long-standing obligation to reimburse Medicare under the Medicare Secondary Payer Act (MSP). However, many are still uncertain what these obligations are, what the penalties for failure to comply include, and how these laws impact claims and litigation involving claimants who may be Medicare beneficiaries. The DRI MSP Task Force has assembled materials to assist you and your clients in making your way toward understanding these, at times confusing, laws and requirements. You will find background information and materials to teach you about the history and intent of the legislation. You will find links to the laws and regulations themselves as well as official government websites that provide additional information and materials. We have also established a listserve accessible through the DRI website to allow for the exchange of information and ideas as we all learn the best way to comply with these obligations, and we are working on a Best Practices Guide for your reference. Please use this website as your starting point for MSP compliance.
DRI also takes this opportunity to introduce you to the Medicare Advocacy Recovery Coalition (MARC) http://www.marccoalition.com which has been collaborating and developing strategic alliances with Congressional leaders and government agencies to focus on broader MSP reform. Presently MARC has 45 active member organizations comprised of entities representing virtually every sector of interested stakeholders including attorneys, brokers, insures, insurers, insurance and trade associations, self-insureds and third-party administrators. DRI is a member.
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E-News Flash
On July 26, the Centers for Medicare and Medicaid Services (“CMS”) posted Version 3.1 of the MMSEA Section 111 NGHP User Guide (the ‘User Guide”). The additions or corrections in the User Guide relate primarily to technical/system issues; however, the following changes in Version 3.1 may warrant your attention:
- 1) Section 8.2 has been updated to require that all Responsible Reporting Entities (“RREs”) are expected to move to a production status within 180 days after initiation of the registration process (the initial registration on the Section 111 reporting website);
- 2) Section 11.10.2 of the User Guide addresses how two defined groups of RREs are required to handle write offs and situations where property of value is provided (one group includes providers, physicians and other suppliers, and the second group includes any other RRE ) ;
- 3) If the RRE has only the Social Security Number for an injured party and after submitting the query request, Medicare provides the Health Insurance Claim Number (“HICN”), the HICN must now be used going forward and Sections 11.1.1, 11.10.1 and 12 provide that RREs must store the HICN returned on response files in their internal systems; and
- 4) If the RRE has no new information to supply on a quarterly update file, the RRE is not required to submit an “empty” Claim Input File
Webcasts
Links of Interest
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MSP Committee
Chair
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Vice Chair
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Officer Liaison
 | Picadio Sneath Miller & Norton, P.C.
Pittsburgh, PA
Phone: (412) 288-4013
E-Mail: hsneath@psmn.com |
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Ex-Officio
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Staff Liaison
 | DRI - Deputy Executive Director
Chicago, IL
Phone: (312) 698-6204
E-Mail: thowes@dri.org |
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