Since the Medicare and Medicaid SCHIP Extension Act (MMSEA) was passed by Congress in 2007, P&C insurers have been required to report Medicare beneficiary personal injury claims. This reporting requirement is a means of enforcing the 1980 Medicare Secondary Payer (MSP) recovery laws, enabling Medicare to recover health care costs paid on behalf of Medicare beneficiaries who have private liability insurance coverage as the primary payer. Responsible Reporting Entities (RREs) that are non-compliant with Section 111 Reporting requirements can incur fines of up to $1,000 per day per claim.
Some P&C insurers struggle with the querying, reporting and other Medicare beneficiary claims responsibilities. These obligations generally require a disproportionate amount of company resources dedicated to Medicare claims, when Medicare claims usually account for only 10-15% of total personal injury claims. Insurers generally save significant time and money, and avoid costly penalties, when they engage the services of a professional Medicare compliance firm.
Why Do P&C Carriers Need Section 111 Reporting Software?
Medicare’s electronic data interchange (EDI) requirements for Section 111 Reporting can be technically challenging to navigate, and many P&C carriers are not equipped with solutions that adequately meet the needs. However, failure to comply with Section 111 Reporting requirements can have costly consequences, as noted above. Flagship’s Section 111 Reporting software, LumenX®, is a user friendly and secure solution that ensures full compliance with all Section 111 Reporting requirements.
What Are The Technical Requirements For Reporting Compliance?
The technical specifications of Section 111 Reporting necessitates specialized software that can handle every aspect of querying, plus the reporting required by Medicare. The reporting process starts with the system’s advanced querying tool, which allows insurers the ability to scan Medicare’s database on a monthly basis to determine which of their personal injury claimants are Medicare beneficiaries. Consistent queries, done properly, are crucial to achieving 100% compliance.
Medicare querying has two prerequisites:
- Query all claims that involve a personal injury;
- Ensure that the data elements required for a query of Medicare’s database are included and accurate.
Advantages of Flagship’s Section 111 Reporting Software
Flagship’s LumenX system offers a dedicated and fully integrated IT infrastructure designed to allow clients to easily and efficiently fulfill all Section 111 Reporting responsibilities. It is the most comprehensive, accurate and easy to use Section 111 Reporting software. If a claim is missing any of the required data elements to complete the querying process, Flagship’s LumenX system alerts the user to the missing information.
Coupled with our expertise and experience, the LumenX system ensures that Flagship’s clients are in complete compliance, and frees up claim adjusters and other insurance company resources for the multitude of pressing non-Medicare obligations.
Here are key features to look for in an effective Section 111 Reporting software system, all of which are included in Flagship’s LumenX system:
Section 111 Reporting Software integrates easily with insurer’s existing software platform and workflow. No insurer wants another time-consuming systems infrastructure “project.”
High Acceptance Rate
LumenX achieves a 99.96% Medicare acceptance rate, saving insurers the frustration of having to re-report rejected claims.
Easy-to-use interface that provides an easily accessible, windows-based user experience, that makes reporting and tracking relatively simple even for non-technical claims professionals.
Secure Data Exchange
All data entered into, and stored, in the LumenX system is encrypted and secure, ensuring your company is compliant with data security/privacy requirements.
Provides a record of every submission and response, establishing a comprehensive and searchable audit trail for all Medicare claims. Records are easily accessible for individual and aggregate submissions to, and responses from, Medicare.
Overcoming Section 111 Reporting Hurdles
Flagship’s LumenX system is constantly updated to keep pace with continuously-changing Medicare rules. We know firsthand about the complexities that can arise in complying with Medicare’s reporting requirements, and no one is better prepared to deal with them than Flagship.
The LumenX system is easy to install and easy to use, with a highly accurate track record. Installation is not a major project that is time consuming and intrusive. It can usually be client ready for use within one week, and is a superb solution for all Section 111 Reporting requirements.
- Ghostbusters (11/1/2019) - In 1984, Ivy League trained parapsychologists Venkman, Stantz, and Spengler started a ghost-catching business in New York City, despite implausible research, and eventually were welcomed as heroes by saving the city from the paranormal disguised as giant marshmallow man Stay Puft. Only in the movies! But, we can use this ghoulish time of the year to serve as a reminder: Don’t let MSP enforcement claims by Medicare Part C Advantage Plans sneak up to shock and detract your standard claims operating procedures. Identifying and resolving these repayment claims may be just as important a part to your overall MSP compliance strategy as similar claims by traditional Medicare Parts A and B.
- How far is too far when negotiating Medicare release terms? (10/7/2019) - At the recent NAMSAP Educational Conference in Baltimore, during a breakout panel discussion on “Leveraging Settlement with Medicare Set-Asides in Mediation”, a rather strident concern was raised with respect to the reasonable scope of terms in a settlement release irrespective of the type of primary plan covering the loss. Specifically, attendees questioned whether Medicare eligible individuals could or to what extent may release their claim or claims in the future to these public health and welfare insurance benefits while negotiating compromise settlement provisions under liability, no-fault or workers compensation plan.
- Treasury Trove (9/17/2019) - Medicare is paid for through two Trust Fund accounts—Hospital Insurance and Supplementary Medical Insurance—held by the United States Department of Treasury, How Is Medicare Funded. In 2018, over 60 million people were covered by Medicare with over $731 billion in total expenditures from the Trust Funds Facts on Medicare Spending and Financing. Further, CMS reports validating $493.68 million in recoverable mistaken conditional payments, while returning $98.68 million dollars to the Medicare Trust Funds in 2018 as a direct result of its recovery program activities, on top of $131.78 million in 2017, MSPRC Commercial Repayment Center in Fiscal Year 2018. Collection activity by the United States Department of Treasury (DOT) on Medicare conditional payments is reportedly increasing in 2019, plus, over the past 15 months, the United States Department of Justice reached six-figure settlements with two Plaintiff’s law firms for failure to repay Medicare conditional payments.