Media Room

Industry News

INSURICA Legislative Brief: Complying with MMSEA Section III

Medicare Secondary Payer: Mandatory Reporting

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA Section 111) adds mandatory reporting requirements with respect to Medicare beneficiaries who have coverage under group health plan (GHP) arrangements as well as Medicare beneficiaries who receive settlements, judgments, awards or other payment from liability insurance (including self-insurance), no-fault insurance, or workers' compensation. Liability insurance includes general liability, auto liability, products liability and any other liability insurance where bodily injury may be covered.

Implementation dates are January 1, 2009 for GHP arrangement information, and October 1, 2009 for information concerning liability insurance, no-fault insurance and workers' compensation.

INSURICA's Legislative Brief offers a high level overview of the mandatory reporting requirements for liability insurance, no-fault insurance, and workers' compensation. For more information on the GHP reporting requirements, please contact INSURICA's employee benefits department.

Background:
Medicare has been unable to consistently identify primary payers since the passage of the Medicare Secondary Payer Statute in 1980. To remedy this situation, MMSEA Section 111 was passed in late 2007. The Act adds mandatory reporting requirements for liability insurance (including self-insurance), no-fault insurance and workers' compensation. These requirements impose an obligation on primary payers to identify claimants entitled to Medicare and to electronically report those claims to Medicare. If you are considered a Responsible Reporting Entity (RRE) under the Act, this law affects you. You should take certain actions immediately to assure your compliance to avoid potential penalties.

Who is an RRE:
You are an RRE if you have (or had in the past) a self insured program; and/or a policy with a Self Insured Retention (SIR); and/or a deductible policy in which claims were administered by a party other than the insurance company (i.e. you or a third party administrator); and/or a self insured pool or captive where you were the claims funding source and controlled payment of claims. If you have any question or concern about whether you may be considered an RRE under the Act, please contact your INSURICA agent.

Responsibility of an RRE:
The RRE must register with CMS (Centers for Medicare and Medicaid Services) by September 30, 2009.

An RRE may then delegate reporting responsibility to an agent(s) (e. g. a third party administrator or vendor), but the RRE remains ultimately responsible for the reporting, and will be held liable for any penalties associated with non-compliance. The Act imposes penalties of $1,000 per day for each claim that is not reported.

No other entity may register on behalf of an RRE.

For additional information and instructions on how to register, please download the entire Legislative Brief.

Download PDF