Read current MMSEA Section 111 Mandatory Insurer Reporting News and Updates authored by the former MSPRC Program Director. Centers for Medicare and Medicaid Services (CMS) promulgated the Medicare Medicaid and SCHIP Extension Act of 2007 to require Responsible Reporting Entities to report ongoing responsibility for medical payments or a payment, judgment or award to a Medicare beneficiary.  The law has become know in the insurance community variously as Section 111, Mandatory Insurer Reporting or MMSEA.  CMS released their first guidance in 2008 and user guide in 2009 (this author participated in its development).  Since that time, CMS has held numerous teleconferences and issued several updates to their user guide.

Latest News and Information

Attorneys should check for additional articles by navigating to Attorneys under Medicare Secondary Payer

Flurry of CMS Alerts: What is going on with reporting liability?

Clinical Trials

Clinical Trials Update  CMS publishes User Guide with no changes

The Debate About Reporting is Over for Two Leading Pharmaceutical Companies After Meeting with CMS

CMS holds a meeting at the request of two pharmaceutical companies -- probes clinical trial billing practices and clarifies reporting.

Is Medicare unknowingly underwriting clinical trials? Pharmaceutical, Medical Device and Biotechnology companies are all required to report their responsibility for treating clinical trial subjects under Section 111

Health Retirement Accounts

Medicare is watching: Report your HRA.  Rumor in the industry is that a number of HRA administrators have decided not to report because they think they will escape under the radar.  Learn how Medicare can find them and fine them.

Reporting Health Reimbursement Accounts to Medicare.  The Second Quarter of 2011 is the mostly likely time that Responsible Reporting Entities need to report a Group Health Plan (GHP) Health Reimbursement Arrangement (HRA) to meet Medicare Section 111Mandatory Insurer Reporting Requirements.

Hosptial Risk Management Write-Offs

Reporting Hospital Risk Management Write-Offs (Updated August 2010) How and what to report

In General

Piatt Consulting Announces Medicare Consul Services Small Business Solution -- MCS offers a low cost,  web-based solution to manually report a few claims a year.

Medicare issued Alert on Total Payment Obligation to Claimant -- Might be confusing to liability insurers.  This article attempts to explain the rationale and reporting mechanism if liability plan pays before settlement.

Frequently Asked Questions

How can I query more than 500 claimants and still use Medicare's Direct Data Entry?

Case law supports collecting HICN.  A recent case heard by the Nebraska District Court in Seger v Tank Connection may help insurers obtain a claimant's personal information

Hidden Dangers in those Pesky ICD 09 Codes (Updated) Reporting the wrong ICD 09 codes can have unintended consequences including improper demands for reimbursement and a cause of action on the behalf of the claimant.

Some things to consider when contemplating a liability set-aside They are not required by statute, regulation or CMS, but in an abundance of caution may be useful in documenting your settlement

Old Issues worth keeping in mind

Compliance Flags likely for Workers' Compensation Claims (Resolved) Subsequent claims that break ORM thresholds are likely to be found out of compliance for timely reporting.

Workers' Comp and multiple TPOCs (UPSET 27 May 2010) present a reporting problem for RREs and Medicare.

Reporting Undocumented Workers under Mandatory Insurer Reporting (Resolved)

Captive Reporting Requirements (Resolved)

Excess or Stop Loss Insurers Reporting Requirements (Resolved)

Reporting self-insured employer "deductibles." (Resolved)

Designating Third Party Administators (Administratvie Services Only) as GHP Responsible Reporting Entities (RREs) (Resolved)

No Fault Insurance has a broader meaning to CMS than industry expected