Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added mandatory reporting requirements with respect to Medicare beneficiaries who receive settlements, judgments, awards or other payment from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation, collectively referred to as Non-Group Health Plan (NGHP) or NGHP insurance. The purpose of the Medicare Secondary Payer Act is to protect Medicare’s interests by making Medicare secondary to all other medical coverage when an injured person receives — or may receive — Medicare benefits.  What previously applied to group health plans (GHP) and workers’ compensation, now applies to all forms of payers including pools like CIRA and all of its members individually. More information about Mandatory Insurer Reporting can be found on the Centers for Medicare & Medicaid Services (CMS) website.

If your agency issues payments to any injured person, either directly or through your TPA, you are considered a Responsible Reporting Entity (RRE) and must register with CMS. Neither your TPA nor CIRA can register as the RRE on your behalf. For claims involving existing or potential Medicare beneficiaries, there is no dollar minimum and nuisance settlements are not excluded. The compliance trigger is ANY payment made to a Medicare-eligible person.

CIRA coordinates with its third-party claims administrators to report payments to CMS on our members’ behalf. As a result, registering and maintaining status as an RRE is the only step members need to take. It is imperative that members ensure their Profile Report is re-certified annually to enable reporting. This primarily applies to liability program members as all workers’ compensation payments are issued by CIRA.

• Medicare Compliance Overview (ppt)
• Medicare-related Acronyms