Medicare,
Medicaid & SCHIP Extension (MMSEA) Update
Recently, the
Centers for Medicare and Medicaid Services ("CMS") posted an
alert on its website announcing the availability of a new Direct Data
Entry option for Liability and Workers' Compensation insurers or self-insureds ("RREs") to satisfy their mandatory MMSEA reporting requirements, if the RREs qualify as "Small Reporters." Click
here to view the alert: http://www.cms.gov/MandatoryInsRep/09_Alerts.asp#TopOfPage
A “Small Reporter" is defined as a RRE that will submit 500 or fewer Non Group Health
Plan ("NGHP") reports per calendar
year. Ordinarily, a RRE can use the Query
Function to make a separate inquiry to determine, as a preliminary
matter, whether a claimant is in fact a Medicare beneficiary. The Query
Function, however, is not available if the RRE
selects the DDE option.
Instead, the injured party information is entered first and will
be matched online, in real time, as the data is entered. If no
beneficiary match is found, and the RRE
confirms that the information is complete, then no further data elements
will be required at that time. When an inquiry is submitted and no
matches are found, the inquiry counts toward the 500 claim report limit.
CMS cautions that utilizing the manual submission
method could take considerable time since the same number of data
elements (about 130) would still be required. However, with relatively
few reports required, it would seem that the DDE alternative would be
considerably more economical for Small Reporters, since they would have
no need to hire expensive intermediaries for data entry and could train
their own staff. With only a fraction of cases either involving Medicare
beneficiaries or requiring inquiries about Medicare status, the 500 claim
report limit should be more than adequate for low volume RREs. Since routine discovery will provide the answer
in most cases, there simply is no need to send an inquiry about Medicare
status in every case.
In addition, Small Reporters have no assigned data
submission window. Rather, they are required to submit reports within 45
calendar days of the Total Payment Obligation to Claimant ("TPOC") date or within 45 calendar days of
assuming Ongoing Responsibility for Medical Payments ("ORM"). Since retroactive reporting is required
for ORM existing any time prior to 1/1/2010,
and continuing on or after 1/1/2010 and for certain TPOC
amounts dating from 10/1/2010 through 12/31/2010, an exception will be
made for these claim records to be reported outside the 45 calendar day
grace period.
Small Reporters may begin using the DDE option on
January 3, 2011.
This document is
intended to provide you with general information about MMSEA reporting requirements. The contents of this
document are not intended to provide specific legal advice. If you have
questions about the contents of this update, please contact Tom Charchut
at 310-215-7100 or tcharchut@hbblaw.com or contact your
preferred Haight Brown & Bonesteel attorney. This communication may
be considered advertising in some jurisdictions.
|
