Health Care Client ALERT: CMS Implements Requirement to Report Claims Payment Information
Under the Medicare, Medicaid and SCHIP Extension Act of 2007 ("MMSEA"), "applicable plans" will have to register with and report claims payment information to the Centers for Medicare & Medicaid Services ("CMS") for claimants eligible for Medicare. The "applicable plans" required to report, called responsible reporting entities ("RREs"), include self-insurance plans and health care providers with deductibles and other forms of self-insured retention depending on the terms of the policy. For example, if you have a self-insurance program and a payment is made to a Medicare beneficiary to settle a malpractice claim, and part of the settlement is for health expenses Medicare would otherwise pay, the rules apply.
The MMSEA provisions were adopted to give CMS better means to enforce the Medicare secondary payor rules and attendant lien rights, so CMS does not pay for a beneficiary's care when another has primary responsibility, and, more specifically, apply where payments, such as through judgment, settlement, award or otherwise, are made to reimburse a claimant's medical expenses associated with personal injury, illness or death (whether or not the settlement designates any payment for medical expenses) and which have been or may be paid under Medicare. Special rules apply as to continuing liability payments.
The deadlines for compliance have changed from time to time, but the current schedule requires RREs to register with CMS electronically by September 30, 2009, and, effective January 1, 2010, RREs must begin to track claims information to report, although the actual reporting period will commence in the second quarter of 2010, based on a specific reporting schedule set by CMS for that quarter.
Thus, health care providers who maintain self-insurance plans, or are obligated for deductibles or other self-insured retention amounts that would trigger these obligations, must register by the September 30 deadline, and should begin to implement systems to collect the necessary information from claimants to make reports as required. Providers should also begin to work with their risk managers and defense counsel to be sure they are up to date on the requirements and so that the appropriate information can be obtained from claimants, through discovery or other means, to report and otherwise establish compliance, and to otherwise protect against liability for noncompliance or lien enforcement.
There are substantial penalties for failing to comply, so it is very important to act timely and thoroughly. Civil penalties can be as much as $1,000 per day for each day that a report is untimely and which apply to each claim that is not reported. Unsatisfied liens may also be collected from those who do not report.
Walter Williams & Charles Sinsel
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229 West Main Street
Clarksburg, WV 26301
304-624-8000
walter.williams@steptoe-johnson.com
charles.sinsel@steptoe-johnson.com
This alert is a periodic publication of Steptoe & Johnson PLLC and should not be construed or relied upon as legal advice or legal opinion on any specific facts or circumstances. The content is intended for general information purposes only, and you are urged to consult your own lawyer concerning your own situation and any specific legal questions that you may have. For further information about these contents, please contact Steptoe & Johnson PLLC. Walter Williams and Charles Sinsel of Steptoe & Johnson are the lawyers responsible for the content of this alert.