To download a pdf of this advisory, please click here.
CMS has changed the first reporting date for live claim input files from April 1, 2010 to January 1, 2011. This delay effectively gives the defendants/insurers (a/k/a Responsible Reporting Entities or "RREs") an additional nine months to ready themselves prior to live claim input file reporting. While this provides time for some of the confusion to subside, the delay is effectively a matter of deferral, not forgiveness.
The obligation to report certain settlements is not going away; it is merely being delayed for nine months. It appears the following trigger dates will continue to exist as previously conceived (subject to CMS' pending Version 3.0 of the User Guide and its Alert to be issued next week):
1. for lump sum awards, settlements on or after January 1, 2010 will be reportable;
2. for settlements containing an ongoing responsibility to pay medical expenses, settlements on or after July 1, 2009.
In this regard, unless the next version of the User Guide states otherwise, defendants are still expected to be requesting data from plaintiffs at the time of settlement for settlements occurring in 2010.
The only change is that these settlements do not have to be reported until Q1 2011 as opposed to Q2 2010, depending on the assigned seven (7) day window provided by CMS to the RRE. RREs should use the remainder of 2010 to continue testing their systems to ensure that both query files and claim input files are being transmitted to and from CMS in a manner that is Medicare compliant.
In sum, the basic mandate has not been changed by this deferral. Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (the "MMSEA") imposes reporting obligations on insurers in settlements involving current Medicare beneficiaries. These reporting requirements will continue to cause a lot of anxiety amongst the parties involved in settlements, from the plaintiff-Medicare beneficiaries and their counsel, to the insurance companies and their counsel. As a result, settling counsel should embrace this short deferral as an opportunity to become even more well-versed in MMSEA developments as it may otherwise affect the time it takes to resolve personal injury cases.
CMS has advised that it will publish an Alert during the week of February 22, 2010 providing additional guidance. This Alert should detail the steps RREs can take going forward to ensure ongoing compliance with the Section 111 reporting requirements. Once that Alert is published, Garretson Firm Resolution Group will provide the details to you as we continue to provide practical guidance and interpretation of the ever-changing MMSEA reporting requirements.
Please click here to find the guidance published by CMS.
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