The New MMSEA Reporting Obligations

Question: Could you confirm that the new MMSEA reporting obligations apply to settlements on or after Jan. 1, 2010, and has not been extended to some other date?

Kentucky Attorney

Answer: As of today’s date, we are unaware of any extension of time for the trigger date for RREs needing to report settlements involving Medicare beneficiaries beyond Jan. 1, 2010. Per CMS’ User Guide (version 2.0, dated July 31, 2009), the reporting obligations apply on or after Jan. 1 2010. An excerpt from that Guide is below:

Section 111 RREs are required to register with the COBC and fully test the data submission process before submitting production Claim Input Files. RREs will be assigned a quarterly file submission timeframe during which they are to submit Claim Input Files. Once in a production mode, RREs will submit their initial claim files containing information for all liability insurance (including self-insurance), no-fault insurance, and workers’ compensation claims involving a Medicare beneficiary as the injured party where the settlement, judgment, award or other payment date is January 1, 2010, or subsequent, and which meet the reporting thresholds described later in this guide. In addition, initial claim files must include claims on which ongoing responsibility for medical payments exists as of July 1, 2009 and subsequent, regardless of the date of an initial acceptance of payment responsibility (see the Qualified Exception in Section 11.9). Subsequent quarterly file submissions are to contain only new or changed claim information using add, delete and update transactions.

Note – ORM still requires a July 1, 2009 starting date, but ORM applies to WC cases, not liability cases. In other words, if a RRE agrees to start paying for ongoing medicals after July 1, 2009 and stops paying for those medicals as part of a settlement involving a payment for other damages, that RRE reports twice, with the first report occurring between April 1 and June 30, 2010 for those cases where ORM started on or after July 1, 2009.