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MMSEA Section 111 Update – March 2010

Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007

For the past year insurers have worked towards developing procedures to be compliant with the MMSEA. Signed into law by President George Bush on December 29, 2007, the Medicare, Medicaid and SCHIP Extension Act of 2007 has been implemented by CMS an attempt to curb the rising costs of the Medicare program. MMSEA adds new reporting provisions requiring that insurers report all Workers Compensation, Liability and No Fault claims to the Coordination of Benefits Contractor (COBC), within a time frame designated by the Secretary. A $1000 penalty per day per claim may be asserted for failing to protect Medicare’s interest.

CMS has been in constant communication with the industry over the past year seeking a smooth transition into MMSEA. CMS has recently provided new updates regarding the implementation date of MMSEA, which has been pushed back from April, 1 2010 to January 1, 2011, changing the retroactive reporting date. All claims that are opened on or after January 1, 2010 are now reportable. CMS has stated that older claims can be reported but it is not required. Despite this delay in reporting, CMS encourages that the reporting agents begin test file submissions immediately to workout any problems that may occur. Although CMS has attempted to provide clarity in recent alerts posted on the CMS website, teleconferences, and individual inquiries that are submitted to the dedicated MMSEA mailbox, the industry still anxiously awaits definitive answers and guidance.

Many insurers concerns involve, who is the RRE (Responsible Reporting Entity), periodic indemnity payments, the continuous monitoring of plaintiffs to confirm eligibility, when will RRE’s be penalized? The CMS updates have failed to put the industry at ease and the delay in reporting has many concerned with CMS’ ability to bring about an efficient reporting process. Insurers have spent thousands and in some cases millions of dollars in an attempt to be compliant under the MMSEA, the fact that CMS is unable to provide the clarity that the industry is so desperately seeking causes great frustration. The fact of the matter is until live reporting has taken effect the unknowns will remain.

You can follow all MMSEA updates provided by CMS at www.cms.gov/

Synergy can assist your firm with Medicare Compliance and MMSEA related issues. Contact us at 1(877)907-LIEN (5436). We are here to help!

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