Employers and insurers, heed the good news: We have a three-month implementation delay in the Mandatory Reporting Requirements for Medicare. This is even more important to those who are unaware of the reporting requirements. Two years ago Congress passed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), which added new and significant mandatory reporting requirements for group health plans (GHP) and for liability insurance (including self-insurance), no-fault insurance, and workers' compensation benefits, to report where they have made a payment to a Medicare beneficiary.
With over 78 million American baby-boomers about to age into the system, the intent of the law is to preserve Medicare funds where other insurers are primary to Medicare. The new reporting requirements are being implemented by the Centers for Medicare & Medicaid Services (CMS). All mandatory reporters must register with CMS no later than September 30, 2009; the deadline was originally June 30, 2009.
Many employers will be required to be responsible for reporting, in that they are self-insured for their liability coverage or are considered self-insured under the law based upon the deductible in place for their insurance. While under current law Medicare has been the secondary payer to other insurance for many years, the process has largely been "pay and chase" but with little front-end information to identify the potential sources of such funds. Settlements that covered medical expenses were difficult to identify and track, and beneficiaries were often unable to pay Medicare back when the Medicare Secondary Payer (MSP) issue was identified months or years later.
The penalties for non-compliance with these new obligations are significant - over $1,000 per day, per claim. Since the reporting is quarterly and an employer might not realize it had missed a deadline until the next reporting date, it is conceivable that one missed deadline could result in a liability of $90,000 or more. Furthermore, 42 CFR 411.24(i) permits Medicare to recover from the primary payer even if the primary payer has reimbursed the beneficiary or other party if it was aware or should have been aware that Medicare made a conditional primary payment.
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