The Medicare and Medicaid and SCHIP Extension Act of 2007 comes into effect in 2010.
The new act imposes mandatory reporting requirements for liability insurance (including self insured’s), no fault insurance and workers’ compensation and will impact many organizations.
Simply put; section 111 of this new Act imposes an obligation on the primary payers to identify claimants entitled to Medicare or Medicaid and report these claims to Medicare electronically.
For more information (180 pages) visit the Centers for Medicare & Medicaid Service (CMS) website.
http://www.cms.hhs.gov/MandatoryInsRep/Downloads/NGHPUserGuide031609.pdf
Who needs to report?
The key is to define if your client is likely to meet the definition of a Responsible Reporting Entity (RRE).
The best rule of thumb is:
If you pay a claimant who is Medicare or Medicaid eligible they are the RRE.
The best way to identify the RRE to answer the following:
If you are fully insured on an auto liability policy, with no deductible – The insurance company is the RRE.
If you decide not to report the claim for any reason (Concerns with increased premiums, etc.) – You are the RRE.
If you are self-insured for workers’ compensation up to $500,000, with an excess policy for claims above $500,000. You are the RRE, until the excess policy is triggered.
If you are with the State Fund for Washington Workers’ Compensation – We believe L&I is the RRE.
If you have a protection & indemnity policy for marine exposures, and it is written on a duty to indemnify basis (the insurer reimburses what the client has paid) – Some attorneys are saying you are the RRE; Marine insurers are saying that you are the RRE. This issue has not yet been addressed by the CMS. –
As you can see, there are “gray” areas. But what is certain, if you are or could be an RRE, you will need to register with the CMS during the registration period , beginning July 1 through September 30, 2009.
For more information about registration visit:
http://www.cms.hhs.gov/mandatoryInsRep/05_Computer_Based_Training.asp
A self insured organization with a Third Party Administrator (TPA) can designate the TPA to be the Reporting Agent (RA). However you are still responsible for registering and will remain responsible for the results of that reporting.
What are the consequences of not reporting if you are the RRE?
The penalty for non-compliance is $1000 per day, per claim. So it is important that you register and comply with this new law.
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