Medicare Section 111 Reporting Requirements
Group health plans must report to the Centers for Medicare and Medicaid Services (CMS) Social Security Numbers or Medicare Insurance Claim Numbers for employees and their covered family members who might have Medicare coverage in addition to coverage under the employer group health plan. Many employers with fully-insured health plans have been contacted by their insurers to collect SSNs and HICNs for their participating employees. Self-funded plans may have their own reporting requirements. The reporting, required under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007, helps CMS identify Medicare-covered individuals with group health plan coverage that should pay claims primary to Medicare.
Video: Big Medicare Fraud Bust Nets 111 Doctors, Nurses
MMSEA Section 111 Reporting for All Insurance Types :Gould & Lamb
About the Author: John Miano is the Manager of Reporting Services for Gould & Lamb, LLC. His primary responsibility is directing the implementation of CMS Section 111 reporting programs for our clients. He has over 20 years experience in the Property and Casualty Insurance Industry and is currently an active committee member of the International Association of Industrial Accident Board Committees (IAIABC). He is also a former Executive Board Member of the Association of Workers Compensation Claim Professionals (WCCP) and is a Board Certified Workers Compensation claim adjuster (CWC).
Court Rules That State Bar’s Professional Liability Fund Is NOT Subject to MMSEA Reporting
[A]n attorney may be sued for malpractice for failing to file a personal injury lawsuit within the applicable statute of limitations (citation omitted). In that case, under the PLF’s plan, there could be a viable claim for damages resulting from the PLF-covered activity at issue (practicing law). The potential damages could include medical bills or costs incurred by the attorney’s client that would have been included in the personal injury lawsuit that was not properly filed. The damages that could be awarded through the PLF would account for the difference in the outcome of the personal injury case caused by the failure to timely file the lawsuit (citation omitted). This difference could encompass medical expenses incurred by the client, including those paid or covered by Medicare. Defendant’s Memorandum in Response to Plaintiff’s Motion for Summary Judgment and in Support of Defendant’s Cross-Motion for Summary Judgment, November 14, 2011, at p. 4.
The Official Medicare Set Aside Blog And Information Resource: New MMSEA Section 111 Town Hall Calls Scheduled
MEDVAL, LLC provides pre-settlement and post-settlement services for high exposure workers’ compensation and liability claims that require Medicare’s interests to be protected pursuant to 42 USC 1395y(b)(2). As the first firm in the country to provide a fully integrated, one-stop solution for the Medicare Set-Aside process, we can recommend Medicare Set-Aside arrangements, submit them to the Centers for Medicare and Medicaid Services (CMS) for approval, provide annuity and lump sum funding options, provide post-settlement medical trust administration, and pharmacy benefit management to our clients all under one umbrella.
Section 111 Medicare Secondary Payer Reporting Update
The Centers for Medicare and Medicaid Services (“CMS”) announced an option which will allow for payment of a simple fixed percentage on small dollar liability insurance or self-insurance settlements for physical trauma-based injuries. Effective November 7, 2011, in cases where the settlement is $5,000 or less, a Medicare beneficiary may opt to resolve Medicare’s recovery claim by paying Medicare 25% of the total settlement instead of using the standard recovery process.
MMSEA Section 111 Mandatory Insurer Reporting Updates : Life Sciences Legal Update
Second, CMS has posted revised guidance pertaining to liability insurance (including self-insurance) responsible reporting entities (RREs) where the claims involve exposure, ingestion, and implantation issues. In the guidance, CMS explains its policies for claims involving exposure, ingestion, and implantation. Specifically, CMS discusses when Medicare will, and will not, assert a recovery claim against the settlement, judgment, award, or other payment, and when the MMSEA, Section 111 mandatory reporting rules must (or need not) be followed. CMS also provides examples of various factual scenarios involving exposure, ingestion, and implantation, and discusses how its policies will be applied to each.
MMSEA Section 111 Reporting Requirements
Mandatory Insurer Reporting (MIR) Mandatory Insurer Reporting is when an RRE electronically transmits a claim data file to the COBC. Learn more. We are experts and understand the law, the requirements, and the best practices. Our totally web-based SaaS solution captures, stores, and moves the necessary data to and from Medicare s systems and enables you to become and stay compliant. It s simple
FBI Identifies 107 Persons Arrested In Massive Medicare Billing Fraud Takedown
This indictment charges Eulises Escalona with one count of conspiracy to commit health care fraud, one count of conspiracy to defraud the United States and to receive and pay health care kickbacks, and five counts of payment of health care kickbacks stemming from a $42 million home health care fraud scheme. According to the indictment, Escalona owned and operated Willsand Home Health, Inc. (Willsand), a home health agency that purportedly provided home health and physical therapy services to eligible Medicare beneficiaries. In fact, however, from January 2006 through November 2009, Escalona and others paid kickbacks to Medicare beneficiaries to induce them to become patients at Willsand regardless of medical need and to falsely attest that they had received the purported services. In addition, Escalona and others paid kickbacks to patient recruiters and to doctors who signed fraudulent prescriptions and plans of care (POCs) for unnecessary home health services for patients at Willsand. To execute the scheme, Escalona and others falsified patient files and POCs to make it appear as if the patients had qualified for and actually received home health services. In this way, Willsand allegedly submitted approximately $42 million in false claims to Medicare for services it claimed to have provided to approximately 622 beneficiaries. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.
MMSEA Section 1111 Update
The next phase of CMS’ MMSEA Section 111 reporting for liability Total Payment Obligation to Claimants (TPOCs) including settlements, judgments, awards, or other payments now begin on April 1, 2012. Starting April 1, 2012, the liability TPOC reporting threshold will be reduced from $100,000 to $50,000. More importantly all liability TPOCs greater than $50,000 for TOPCs on or after April 2st through Jun 30th will no be reportable.
CMS Update on MMSEA Section 111 Mandatory Insurer Reporting : Health Industry Washington Watch
CMS recently issued updated information regarding the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), Section 111 "Mandatory Insurer Reporting" requirements. The recent updates address: (1) a revised implementation timeline for certain liability insurance (including self-insurance) total payment obligation to claimant settlements, (2) revised guidance on claims involving exposure, ingestion, and implantation issues, (3) upcoming improvements to the Medicare Secondary Payer (MSP) program, (4) a new exception for certain settlements paid into a qualified settlement fund and (5) a new way for certain injured Medicare beneficiaries to satisfy their past and future MSP obligations. For more information, see Reed Smith’s summary on our Life Sciences Legal Update blog
Health Care Law Blog: WVCLE: Health Care Law 2011 Seminar
The West Virginia Continuing Legal Education Section of WVU College of Law will be sponsoring Health Care Law 2011 Seminar on May 20, 2011, in Charleston, West Virginia at WVU Medical Center – CAMC. The Health Care Law 2011 Seminar will cover a variety of topics of interest to West Virginia health care attorneys. Topics include: Medical Mapractice Update, Protecting Medicare’s Interest Under Section 111 and Mandatory Reporting Requirments, Risk Management Topics for Hospitals, Development and Update on ACOs, HIPAA/HITECH Update and Anatomy of a Health Care Data Breach, Stark and Fraud Abuse Update, and Lawyers and Law Firms as Business Associates. I will be speaking on the changes to HIPAA under HITECH. The title for my presentation is “Anatomy of a Breach: Practical Tools to Handle a Breach and HIPAA/HITECH Updates.” Learn more about the seminar and how to register here.
- Section 111 Medicare Secondary Payer Reporting Update
- Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 Reporting: Identifying Reporting Triggers – 2011 Updates
- Section 111 Medicare Secondary Payer Reporting Update
- Hospitals failing to comply with Medicare requirements, reporting
- Medicare Secondary Payer Reporting Requirements: The Critical Role of Automated Controls and Continuous Monitoring