Medicare legislation has always been somewhat confusing, and complicated by the frequent changes. The framework that governs primary payer responsibilities, including reimbursements for Conditional Payments, is a good example of that, and it leaves many adjusters (and attorneys) scratching their heads. The Medicare, Medicaid, and SCHIP Extension Act, passed in 2007, requires Responsible Reporting Entities (RREs) to report all personal injury claims involving a Medicare beneficiary to Medicare. Although stiff penalties can be levied for failure to comply with the reporting requirements, many insurers struggle with the distinctions and specifics of the MMSEA Reporting (Section 111) and MSP Recovery (think Conditional Payment reimbursement) regulations.
Why Was The Medicare, Medicaid, and SCHIP Extension Act Necessary?
A primary objective of MMSEA is to identify RREs who are primary payers for Medicare beneficiaries for whom Medicare has made Conditional Payments to health care providers. This legislation was passed in response to the Medicare Secondary Payer Act of 1980 (MSP), which made Medicare a secondary payer in personal injury claims. But until the MMSEA legislation in 2007, there was no effective means for identifying the primary payer when one existed. MMSEA Section 111 Reporting requirements now make it possible for Medicare to identify the primary payer, which in turn helps to ensure Medicare is reimbursed for Conditional Payments, or knows where to go to recover it.
What is the impact of MMSEA on Insurance Carriers?
Under the 2007 MMSEA, insurance carriers can be penalized up to $1,000 per day per claim, when they fail to report. This stipulation sent shockwaves through the industry, and many insurance entities scrambled to ensure they were in compliance with Medicare Section 111 Reporting requirements. MMSEA stipulated that these entities would be known as Responsible Reporting Entities, and they have a legal obligation to keep Medicare informed when they enter into or make any settlements, judgments, awards or other payments to Medicare beneficiaries as a result of personal illness, injury or workers’ compensation claims.
Flagship’s Comprehensive Reporting Services
The route to 100% Medicare compliance can be difficult and expensive to navigate, especially if it is being done internally. Enlist the services of Flagship Services Group to avoid non-compliance reporting penalties and reduce your Conditional Payment liens. Our medical, legal and claims professionals have unsurpassed knowledge of the Medicare system and its continuously changing regulations. Flagship’s proprietary Section 111 Reporting system, LumenX®, can keep you up-to-date on all Section 111 Reporting deadlines and requirements.
- Are You My Mother? (12/3/2019) - In Dr. Seuss’ classic book, a determined baby bird is searching for his mother but does not know what she looks like. Under Medicare Secondary Payer (MSP), certain insurers encounter similar problems trying to figure out whether it is a Primary Plan with Section 111 and reimbursement obligations.
- Into the Looking Glass (11/20/2019) - Business organizations face all kinds of risk. Developing strategic risk management plans as a business practice is becoming more prevalent across industry lines which help the organization define, measure, anticipate, and respond, for example, to foreseeable risks, technological developments, as well as changing laws and regulations. Some risk is insurable, while other kinds may necessitate capital, cost or other investment such as an organization adding new personnel or contracting with subject matter specialists or consultants. Some risk is not as perceptible as others, yet still must be handled if it occurs. Ideally, an effective risk management plan is tailored to the organization and ultimately improves its performance by avoiding, minimizing or mitigating risk.
- 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.