August 2011: CMS Releases Updated MMSEA Section 111 User Guide

CMS recently released User Guide Version 3.2 for Medicare Secondary Payer Mandatory Reporting in Non-Group Health Plans (NGHP). User Guide Version 3.2

August 2011: CMS recently released ICD-9-CM Version29 codes which will be effective for Section 111 Reporting starting October 1, 2011.

To see ICD-9-CM Version 29 along with earlier versions please visit the CMS website:

http://www.cms.gov/ICD9ProviderDiagnosticCodes/06_codes.asp

June 2011: MedAllocators achieves 97% success rate in acceptance of claims for Section 111 compliance:

MedAllocators, Inc. the nation’s largest independent MSP Compliance company focused on the workers’ compensation and liability claims markets, has reported that after querying and reporting over 250,000 claims per month, they have a 97% acceptance rate for Section 111 claim submitted via its MedAllocators Reporter comprehensive web based reporting solution. Read Full PRESS RELEASE

May 2011: Medicare Secondary Payer--Workers’ Compensation--INFORMATION

CMS recently issued a new memo addressing MSA review thresholds in workers compensation. The memo does not change any CMS policies; rather it is a reminder of the review thresholds which have been in place for more than five years. (Read Alert)

May 2011: MSRPC Issues Alert Advising of Temporary Suspension of Issuance of the Rights and Responsibilities and Demand Letters. While the Centers for Medicare and Medicaid Services and the MSPRC have not stated a reason, we believe it stems from a May 5, 2011 federal court decision from Arizona in the case of Haro v. Sebelius. To learn more about this alert, read the Special Edition MSA Insider that addresses this alert. (MSA Insider)

December 2010: ICD9 Default Codes Released by CMS. In very limited circumstances, as of January 10, 2011, when the claim report does not reflect ongoing responsibility for medicals (ORM) and the insurance type is liability, a value of “NOINJ” may be submitted in both Field 15 Alleged Cause of Injury, Incident, or Illness and Field 19 ICD-9 Diagnosis Code 1 (“NOINJ” must be put in both the alleged cause and first diagnosis field and all the rest of the diagnosis fields must be blank). All other fields must be submitted on the claim report as required. (Read MedAllocators' Report)

Read CMS Alert on Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation - Special Default ICD-9 Code for Responsible Reporting Entities (RREs) (Read Alert)

November 2010: All Section 111 reporting will remain intact for current RRE assigned submissions periods with the following exception:

Any Liability TPOC claims will not need to be reported until the first quarter of 2012. The mandatory look back date for reporting Liability TPOC’s has also changed to October 1, 2011. The dollar thresh hold values for reporting these and all other TPOC type claims including Workers Comp will remain at $5,000 up till January 1, 2013.

I want to stress that all other claims including ORM for Workers Compensation, TPOC’s for Workers Compensation and all No-Fault claims must still be reported during current assigned submission periods. However, CMS continues to encourage RREs to report their TPOC liability claims in their current submission period. (Read ALERT)

August 2010: With Mandatory Insurer Reporting set to finally take effect on January 1, 2011, the insurance industry, litigants, beneficiaries and legal practitioners continue to face uncertainty regarding Medicare, Medicaid and SCHIP Extension Act (MMSEA) Section 111 Reporting Requirements. This is particularly true in mass tort litigation. (Read Mass Tort Statement)

August 2010: Another error code has been added in the 3.1 Version of the NGHP User’s Guide. It is FP 31. This happens only in a rather complicated situation, and hopefully will not happen often, but we do need to notify you of it because we have actually seen this condition on a recently submitted production file. (Read Error Code Statement)

July 2010: CMS releases the newest MMESEA, Section 111 User Guide: Version 3.1. To view the entire Guide Book. (Guide Book V 3.0)

May 2010: Medicare Secondary Payer-Workers’ Compensation-INFORMATION

The purpose of this memorandum is to clarify guidance provided in the Centers for Medicare & Medicaid Services’ (CMS’) April 3, 2009 and July 1, 2009 procedure memoranda regarding prescription drugs administered to Medicare beneficiaries...(Read Alert)

March 2010 : ALERT for Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation: WHO MUST REPORT

This document provides information regarding who/what entity is a MMSEA Section 111 Responsible Reporting Entity (RRE) for Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation. (Read Alert)

February 2010 :

CMS DELAYS IMPLEMENTATION OF SECTION 111 MANDATORY REPORTING TO JANUARY 1, 2011

The Centers for Medicare and Medicaid Services (CMS) has announced a delay in the implementation of Section 111 Mandatory Reporting for Non-Group Healthcare Providers (NGHP), otherwise known as Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation plans, from April 1, 2010 to January 1, 2011. According to the CMS statement (see below), the testing period which was to have ended March 31, 2010, will now be extended to the end of 2010.

Nonetheless, CMS further states that Responsible Reporting Entities (RREs) which have completed their testing may proceed with reporting of files prior to January 1, 2011. This statement from CMS also does not change the reportable claims which remain as follows:

• All individuals who are Medicare eligible and have received a settlement, judgment, award or other payment since January 1, 2010; or
• All individuals for whom an RRE has assumed ongoing responsibility for medical payments (ORM) since July 1, 2009.

What should you be doing now!

September 2009: CMS releases an ALERT: Complaince Regarding Obtaining Indivual HICNs and/or SSNs for Non-Group Health Plan (NGHP). (Read Alert)

The included model language is recommended by MedAllocators for entities attempting to obtain HICN & SSN information from a claimiant. (Model Language)

The September MSA Insider addresses these ALERTS. (View Insider)

August 2009: CMS releases the newest MMESEA, Section 111 User Guide: Version 2.0. To see a summary of changes view the August 2009 MSA Isider or view the entire Guide Book. (Guide Book V 2.0)

August 2009: This draft document provides additional detail regarding who/what entity is a MMSEA Section 111 Responsible Reporting Entity (RRE) for Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation. (Memo)

July 2009: ALERT to address Workers' Compensation payments (Memo)

April 2009: A memorandum is set forth by CMS regarding the methodology of pricing future prescription drug treatment costs/expenses in Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) proposals. (PDF)

March 2009: CMS Release MMSEA, Section 111 Guide Book. (Guide Book)

November 2008: CMS Definitions for an Responsible Reporting Entity (RRE)

CMS Definitions of an RRE (extracted pages)

Original Supporting Statement for the MSP

October 2008: Update on MSP Mandatory Reporting:

Reporting Act Interim Record Layout

Reporting Act Timeline

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