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.
- 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.
- CMS Favors Professionally Administered Lump Sum MSA (9/5/2019) - Amidst the NPRM chatter on Medicare Set Asides (MSA), with an October action date in the horizon, this is an opportune moment to calmly deliberate on key indicators.