The Centers for Medicare & Medicaid’s (CMS) issued three alerts last week, which provide additional guidance for the new reporting requirements pursuant to Section 111 of Medicare, Medicaid, and SCHIP Extension Act of 2007. In addressing how NGHP RREs can remain in compliance with the mandatory reporting requirements, CMS provided the following statement:

CMS stated that RREs are expected to compile the data required by the Section 111 Reporting Requirements. CMS advises RREs to regularly monitor the Mandatory Insurer Reporting Website for updated notifications about the Section 111 Reporting Requirements.

CMS provided further clarification on what RREs must report when they begin reporting on January 1, 2011. For settlements that occur in 2010, RREs are required to report: (1) Total Payment Obligation to the Claimant (TPOC) amounts with TPOC dates on or after October 1, 2010; and (2) claims on which ongoing responsibility for medicals (ORM) exists on or after January 1, 2010. Please note that even if RREs are not required to report settlements that occur before October 1, 2010, they are still required to satisfy Medicare’s lien with respect to any conditional payments it makes on behalf of Medicare beneficiaries.

Additionally, CMS provided clarification regarding which entity is the reporting entity in various circumstances. For example, where there are multiple defendants involved in a settlement, an agreement to have one of the defendant’s insurers issue any payment in obligation of a settlement, judgment, award or other does not shift RRE responsibility to the entity issuing the payment. All RREs involved in the settlement remain responsible for their own reporting. Additionally, for a settlement, judgment, award or other payment with joint and several liability, each insurer must report the total settlement, judgment, award, or other payment, not just its assigned or proportionate share.

Please click here to see the mandatory reporting alerts from CMS.