As we have reported in previous client alerts (see links below), many employers, providers and insurers (including self-insured entities) are required by law to report to the Medicare Program any payments or settlements for liability insurance (including self-insurance), no-fault insurance, and workers' compensation benefits made to a Medicare beneficiary.

On February 17, the Centers for Medicare and Medicaid Services (CMS) extended the reporting deadline from April 1, 2010 to January 1, 2011. This extension is a welcome relief to all Responsible Reporting Entities (RREs) which are required to report non-group health plan (NGHP) claims. Many RREs have been reporting significant problems with test files, including reported instances of CMS losing data files transferred.

The statement from CMS reads in part: " . . . the date for first production NGHP Input Files is changed from April 1, 2010 to January 1, 2011, effective immediately.

  • NGHP File data exchange testing will continue. All NGHP RREs should now be registered with the COBC, and either in or preparing for file testing status. NGHP file data exchange testing may continue during 2010, as needed.
  • All NGHP file data exchange testing will be completed by December 31, 2010. NGHP RREs that have completed file data exchange testing at any time are encouraged to proceed to production file data exchange status."

RREs must remember that any ongoing responsibilities for medicals (ORMs) entered into as of July 1, 2009 and any settlements or payments after January 1, 2010 are still subject to the reporting requirements; the only delay in the implementation is when the reporting must begin.

The February 17 posting also stated that next week CMS will post the next version of the "Section 111 NGHP User Guide" and a number of Alerts relating to particular NGHP policy issues. This information is highly anticipated, and may finally include guidance on provider write-offs, mass tort and product liability issues that have been outstanding for over a year.

CMS has stated that during the week of February 22, they also will post an alert for NGHP RREs describing the steps those RREs can take to assure their ongoing compliance with the Section 111 reporting requirements.

See below for links to prior alerts: