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On November 9th, the Centers for Medicare and Medicaid Services (“CMS”) posted an alert (the “Alert”) on its website extending, once again, the trigger and reporting dates for most liability settlements. The Alert also extends the dollar thresholds for reporting by one year.
Extension for Reporting:
Liability insurance (including self-insurance) total payment obligations to claimant (“TPOC”) (see footnote 1) must be reported if the settlement date is on or after October 1, 2011 (rather than October 1, 2010 as required by Version 3.1 of the User Guide (see footnote 2)). The reporting must be no later than the designated submission window in the first quarter of 2012.
The reporting requirements for cases that include on-going recurring medicals (“ORM”) have not changed; therefore, there are no reporting changes for workers’ compensation, liability settlements that include ORM, or no-fault cases. These cases must be reported no later than the designated submission window during the first quarter of 2011.
The Alert states that if the reporting entity wishes to report liability (including self-insurance) TPOC settlements prior to the first quarter of 2012 they are allowed to do that. The reporting entity must report during their assigned quarterly submission window.
Extension of Current Dollar Thresholds:
The Alert provides for the interim dollar reporting thresholds, as provided in Section 11.4 of Version 3.1 of the User Guide, to be extended by one year. The dollar amounts have not changed. The thresholds for exemption from reporting are summarized as:
• Settlement date prior to January 1, 2013 and amount is $5,000 or less
• Settlement date during 2013 and amount is $2,000 or less
• Settlement date during 2014 and amount is $600 or less
How does this affect you?
This Alert provides an additional twelve months for CMS and the reporting entities to prepare for the mandatory reporting of liability claims. This deferral does not, however, change the need for all parties to ensure that Medicare’s interests are being protected for past and future medical expenses. Actions items to ensure verification, resolution, and reporting include the following:
• Proper release language is incorporated in settlement documents to protect all parties
• Processes are in place to ensure compliance
• Train for the who, what, when and why of compliance
• Query open claims to determine Medicare beneficiary status
• Begin reporting cases to guarantee that the processes are in place well before the mandatory reporting date
The Garretson Resolution Group is available to answer your questions about the provisions of this Alert. Please contact us if you would like us to review or help develop your internal processes and to provide training for all parties that are involved in the resolution process.
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