Complying with New Medicare Reporting Requirements
Insurance companies offering liability coverage, workers compensation, and those that are self insured have struggled to prepare for the new Medicare reporting requirements since the federal mandates were announced. The legislation is expected to reduce Medicare costs by protecting its secondary payer status when eligible claimants can be covered by alternative sources. Unfortunately for insurers, the new laws will increase paperwork, but failing to act on them will carry stiff penalties.
In contrast with previous legislation, the burden of proof now rests on insurers to determine whether tort plaintiffs are eligible for Medicare coverage, and to report this information to the government. The additional tracking can be considerable for those with eligible claimants. Insurers with minimal or no electronic files face the greatest challenges.
The drive toward compliance recently picked up speed: registration opened in May, 2009 for Responsible Reporting Entities (RREs) to express their intent to comply with the electronic reporting requirements. Those who haven’t adjusted their plans, policies, and systems to enable timely reporting must take action soon. Federal delays in enacting the legislation have ended. Fines for non-compliance or late reporting will be severe.
I asked Art Meadows, President and CEO of Panhandle Farmers Mutual Insurance Company and a recognized leader in the insurance field, if he would share some tips to help other insurers make sure they’re able and ready to comply. He shared his expertise and advice during a recent interview:
Q: What are the issues associated with the new legislation?
A: There are a number of requirements for insurers. First, they must identify claimants who are eligible for Medicare benefits. Ideally, they periodically download a list of Medicare-eligible claimants from their digital file repository and operating system that shows all pending claims and upload it to the Medicare site, or they can create and post the lists manually. As it currently stands, quarterly reports will be due starting in 2010. All pending claims must be tracked and reported as long as each claim remains open. If settlements, awards, or judgments are made, these also must be reported.
For insurers, the new legislation is all about facilitating compliance, mitigating risk, and minimizing the corporate expense of managing pertinent information.
Q: What kind of penalties are there for late or omitted reports?
A: Penalties are stiff, amounting to $1,000 per claimant per day. Since reporting will be quarterly, it could take a long time for companies to discover if they’ve made a mistake or omission. Fines could easily amass into hundreds of thousands of dollars with a small number of omissions or late reports. My advice to insurers: don’t just count on employees remembering to file, even if your company is small and files seem manageable.
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Complying with Reporting Requirements
As someone who lives in the bizarre world of Medicare on a daily basis, this is the right thing to do. For too long, the provider has had the onus of trying to explain to lawyers and auto insurance carriers, that Medicare becomes an MSP if there is other TPL (Third Party Liability) carriers. We get told we will be sued, reported, or just left out of the payment loop if we do not bill Medicare. As an employee of a medical provider organization, we have tried for years to comply while hospitals, physician's, and other providers and suppliers just file Medicare and Medicaid because it is the quickest and often the easiest to do. I applaud this action. Now, someone needs to tackle the dialysis issue. Dialysis centers need to be the responsible provider for ambulance transports. Only then will physician's, nursing homes, and dialysis centers stop ordering needless stretcher transport to fit their agenda while leaving ambulance services transporting patients for free because they do not meet medical necessity. Only by placing the responsibility on the right sector can we even begin to solve our health care crisis.