Synergy Blog

MMSEA Section 111 Update – March 2010

Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007

For the past year insurers have worked towards developing procedures to be compliant with the MMSEA. Signed into law by President George Bush on December 29, 2007, the Medicare, Medicaid and SCHIP Extension Act of 2007 has been implemented by CMS an attempt to curb the rising costs of the Medicare program. MMSEA adds new reporting provisions requiring that insurers report all Workers Compensation, Liability and No Fault claims to the Coordination of Benefits Contractor (COBC), within a time frame designated by the Secretary. A $1000 penalty per day per claim may be asserted for failing to protect Medicare’s interest.

CMS has been in constant communication with the industry over the past year seeking a smooth transition into MMSEA. CMS has recently provided new updates regarding the implementation date of MMSEA, which has been pushed back from April, 1 2010 to January 1, 2011, changing the retroactive reporting date. All claims that are opened on or after January 1, 2010 are now reportable. CMS has stated that older claims can be reported but it is not required. Despite this delay in reporting, CMS encourages that the reporting agents begin test file submissions immediately to workout any problems that may occur. Although CMS has attempted to provide clarity in recent alerts posted on the CMS website, teleconferences, and individual inquiries that are submitted to the dedicated MMSEA mailbox, the industry still anxiously awaits definitive answers and guidance.

Many insurers concerns involve, who is the RRE (Responsible Reporting Entity), periodic indemnity payments, the continuous monitoring of plaintiffs to confirm eligibility, when will RRE’s be penalized? The CMS updates have failed to put the industry at ease and the delay in reporting has many concerned with CMS’ ability to bring about an efficient reporting process. Insurers have spent thousands and in some cases millions of dollars in an attempt to be compliant under the MMSEA, the fact that CMS is unable to provide the clarity that the industry is so desperately seeking causes great frustration. The fact of the matter is until live reporting has taken effect the unknowns will remain.

You can follow all MMSEA updates provided by CMS at www.cms.hhs.gov/MandatoryInsRep.

Synergy can assist your firm with Medicare Compliance and MMSEA related issues. Contact us at 1(877)907-LIEN (5436). We are here to help!

TESTIMONIALS

Synergy’s team makes it easy to deal with all of the issues we hate at the end of the case. Dealing with Medicare, ERISA liens, keeping eligibility intact for Medicaid and complicated planning for the client’s recovery. The experts we work with regularly at Synergy do a great job of making sure I am protected as are my clients.

J. Clancey Bounds
Bounds Law Group

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

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