More Claims Eligible for Section 111 Mandatory Reporting Provisions: Reporting Threshold Decreases October 1, 2013

Beginning tomorrow, the mandatory reporting threshold under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 drops from amounts greater than $5,000 to amounts greater than $2,000 for settlements, judgments, awards or other payments agreed to on or after October 1, 2013.

Whether a settlement must be reported depends on the dollar amount of that settlement, judgment, award or payment of damages intended to at least partially resolve a claim and the date that payment obligation was established. The Centers for Medicare & Medicaid Services (CMS) refer to these dollar amounts as the Total Payment Obligation to Claimant (TPOC) and the date the payment was established as the TPOC Date. If the most recent TPOC Date is on or between October 1, 2013 and September 30, 2014, and the cumulative TPOC Amount is greater than $2,000, the TPOC(s) must be reported by the end of the reporting entity’s submission timeframe in the quarter beginning January 1, 2014.

Although not required, TPOCs worth between $300 and $2,000 may be reported.

We recommend that you review your internal procedures to ensure that settlements of more than $2,000 payable to Medicare beneficiaries are reported.

If you have questions or need additional information, please contact Marlene Wilson at the Garretson Resolution Group at 704-559-4300 or at mwilson@garretsongroup.com.