MMSEA Section 111 Mandatory Data Reporting
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 added Mandatory Reporting requirements with respect to Medicare beneficiaries. All liability insurance (including self-insurance), no-fault insurance and workers' compensation insurance must report or face potential penalties for non-compliance. A penalty of $1,000 per claim per day will be assessed against any applicable plan for cases of non-compliance. We provide a fully comprehensive and integrated solution for all your Mandatory Reporting and Settlement Solution Needs. The options include:
- Exporting – All CMS-required fields using our specially designed "easy fill" XML file format for direct data import
- Customization – Add on database that can be synchronized with your claims system
- Manual Entry – All required reporting fields are entered manually through the application portal
Benefits of Service Include:
Our proprietary application is an encrypted, secure, and reliable tool that is a low cost solution for your reporting needs. It provides User-friendly, Single Screen Viewing and Entry Capabilities via a fully integrated web-based application that identifies all claims and their risk levels. The application is designed to meet the regulatory reporting needs of all small, medium, and large sized Insurance Carriers, Self-insured Employers, and Third Party Administrators (TPAs) who handle workers' compensation and liability claims. You can check the status of your claims 24 hours a day, 7 days a week.
- Excellence in customer service with a dedicated point of contact
- Guaranteed on-time, fully Automated Quarterly Reporting to CMS during your assigned reporting period
- Internal Validations completely prepare your claim submission to eliminate any CMS rejections
Advanced Data Analytics
Blackburn Group, Inc.'s MSA RiskPro® Mandatory Reporting System contains the most advanced business rules and technology that are consistent with MMSEA Section 111 regulations. Each claim is validated on entry, either when there is an update by the user or through CMS. In addition, Flags and alerts clearly showing missing fields. All claims are automatically checked for errors by internal validation for response files. In addition, the system utilizes threshold rules to prevent over reporting of claims, thus allowing the user to focus only on those claims that are required to be reported.
MMSEA Section 111 Data Reporting is occurring now. The Centers for Medicare and Medicaid Services will be enforcing allocation reports and compliance for all casualty programs. Are you compliant with the regulations? Recent legislation (Public Law No. 110-173), has expanded the definition of the administrative requirements designed to protect the Medicare system from medical expenses considered the primary obligation of private sector plans, including insured and self-insured workers' compensation, liability and no fault plans.
The Social Security Act requires that parties to a settlement protect Medicare's interests as a secondary payor to other available insurance plans. Protecting Medicare's interests has meant reimbursing monies paid by Medicare as "conditional payments" and establishing an allocation for the payment of future Medicare eligible medical expenses.
The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA-111) creates reporting requirements that will enable Medicare to examine settlements, judgments and awards to ensure that conditional payments are identified and reimbursed. If the settlement does not contain an allocation, Medicare has a statutory right to recover up to the entire amount of the settlement, judgment or award. The Act does not change current practices regarding Medicare Set-Aside agreements (MSAs), however it emphasizes positive enforcement of protection and recovery measures for Medicare with respect to all classes of casualty claims. Keep informed by visiting the CMS website for updates.
Newly Enforced Requirements
The Responsible Reporting Entities (RRE's) or its designated agent must make a specific determination for each claimant under a workers' compensation, liability or PIP (personal injury protection)/no-fault program regarding whether the party is a Medicare beneficiary. For Medicare beneficiaries, information regarding the claimant and claim must be reported to the Centers for Medicare and Medicaid Services (CMS) so that a determination can be made regarding coordination of benefits and applicable recoveries. A penalty of $1,000 per claim per day will be assessed against any applicable plan for cases of non-compliance. Choose our independent, experienced team of professionals that are committed to work for you. We have over 30 years of experience in administering the entire claim adjudication process, including Medicare Set Asides (MSA's). Our MSA Best Practices have been recognized throughout the industry as a leading source of quality management. We understand and appreciate the importance of your time, and are available to compliment your existing resources in reducing your costs on each and every claim file.
Blackburn Group Inc.'s MSA RiskPro® Mandatory Reporting Solution is your one stop shop for complying with the Federally Mandatory Section 111 reporting rules.
Call us at 1 (585) 586-4530 for a free demo today!