Belleville, Ill. – Sept. 12, 2008 – The Centers for Medicare and Medicaid Services (CMS) recently provided more details on Medicare secondary payer reporting requirements that are important for Group Health Plan (GHP) providers to evaluate, according to Allsup. Based in Belleville, Ill., Allsup helps employers coordinate their group health, disability and workers’ compensation benefit plans with Social Security and Medicare.

 

“The important issue to clarify for employers who offer group health plans is that the reporting requirement applies to insurers, third-party administrators and only those employers who both self-administer and self-insure,” said Robert Bridges, national sales manager at Allsup.

 

On Aug. 1, CMS released a Supporting Statement for the Medicare Secondary Payer (MSP) Mandatory Insurer Reporting Requirements (MIR) of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA).

 

As Allsup reported earlier this year, the MMSEA provides mandatory reporting requirements for group health plans and non-group health plans. The mandatory reporting requirements of Section 111 of the MMSEA carry significant penalties for non-compliance. These reporting requirements for GHPs go into effect Jan. 1, 2009, and the financial penalty is $1,000 per claim per day for noncompliance.

 

“The supporting statement specifically explains who is responsible for meeting the reporting requirement,” said Mr. Bridges. Details are provided on page 12 of the CMS-provided document. A complete copy of the supporting statement can be found online.

 

“Those entities affected—the ‘use of agents’—are insurers for group health plans, third-party administrators for group health plans and employers with self-insured/self-administered group health plans,” said Mr. Bridges.

 

Most large employers have insurers, and sometimes third-party administrators, handling their group health plans. “Those are the entities who must fulfill the CMS’ requirement to meet the law. Not the employer,” Mr. Bridges said.

 

Additionally, most major insurers of group health plans already have a voluntary data sharing agreement (VDSA) with the CMS.  “So they are already using this method to report names and accompanying information to the CMS,” he added.

 

Developments related to MMSEA further highlight the opportunity for employers to better coordinate benefits.

 

Through its services, Allsup can help assure that employers’ plan administrators are reporting the maximum number of covered lives who are entitled to Medicare to CMS. These individuals may be disabled employees and retirees, dependents and spouses of disabled employees and retirees, and those under age 65 who may be entitled to Medicare because of a disability. 

 

“Allsup provides expertise and a solid history of helping employers with questions they have about coordinating Medicare benefits,” said Mr. Bridges.

 

Another service to consider is Allsup’s Pre-65/Early Retiree Service that assists in identifying plan participants, such as disabled retirees and disabled dependents and spouses, who already are entitled to Medicare. 

 

In the coming weeks, Allsup will continue to communicate and support providers with details and information about MMSEA.

 

“Knowledge and understanding of CMS requirements are pivotal to our operations,” said Mr. Bridges. “In turn, our experts can share this understanding and keep you informed.”

 

For more information contact Allsup at r.bridges@allsupinc.com.

ABOUT ALLSUP
Allsup Inc., Belleville, Ill., is the nation’s premier provider of Social Security and Medicare coordination services for employers, long-term disability (LTD) and workers’ compensation insurers and third-party administrators. Companies can significantly reduce disability, group health and workers’ compensation liabilities by properly coordinating benefits with Social Security and Medicare programs. Founded in 1984, Allsup offers a comprehensive solution to minimize exposure to the Medicare Secondary Payer laws and produce savings by properly coordinating workers’ compensation benefits with Social Security and Medicare. For more information, visit www.AllsupInc.com.