Concerns mount as Medicare Secondary Payer (MSP) Compliance testing phase begins this month
Belleville, Ill. – Jan. 5, 2010 – The first full week of testing has begun for non-group health plan (NGHP) reporting requirements associated with Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). The foundation is now set for full-speed Medicare Secondary Payer (MSP) enforcement with testing in the first quarter of 2010 and full reporting to follow in the second quarter, according to
Allsup, which works with employers to coordinate their group health, disability and workers’ compensation benefit plans with Social Security and Medicare.
“With so much at stake, it’s critical companies adapt and respond appropriately to this new environment,” said Rob Sokol, director of commercial sales-Medicare Secondary Payer compliance at Allsup.
“As of Jan. 1, all responsible reporting entities (RREs), without exception, must comply with MMSEA reporting requirements or face stiff penalties of $1,000 per claim per day and other liabilities. To minimize their risk, insurers should be registered and have already begun the setup and testing process to meet mandatory insurer reporting requirements.”
These complex and more detailed requirements present challenges for the industry, and many companies are scrutinizing internal processes and the role of MSP service providers such as Allsup.
Mr. Sokol pointed out that compliance with MMSEA is no easy task, requiring proactive measures along with extensive preparation and organization.
“Non-group health plans (NGHPs) need to ensure they have the capacity to effectively conduct queries about the Medicare eligibility of all of their claimants, as well as the technological capabilities to satisfy the rigorous new data collection that the Centers for Medicare & Medicaid Services (CMS) now requires,” he explained.
CMS stipulated that beginning in mid-2009, liability insurers, self-insurers, no-fault insurers and workers’ compensation insurers must determine the Medicare beneficiary status on all claims and report those claims involving a Medicare beneficiary to the U.S. Secretary of Health and Human Services.
MMSEA reporting requirements are designed to protect Medicare as the secondary payer through detailed reporting and severe penalties for noncompliance.
To avoid these penalties and other liability, according to Mr. Sokol, NGHPs must (if they have not already done so) take the following steps to ensure compliance with the new law:
- Complete RRE registration. RREs must register electronically with Medicare’s Coordination of Benefits Secure Web site (COBSW) to create the required secure interface for forwarding data.
- Establish/initiate claim procedures to determine the Medicare status of claimants.
- Complete a first round of data exchange, or test submission, to confirm that RREs, either directly or through a designated agent, are able to provide files including all the required information in the appropriate format and according to the CMS-defined schedule.
- Begin quarterly claim file testing effective Jan. 1, 2010.
“2010 marks the first time compliant reporting is required,” Mr. Sokol said. “Without quarterly reporting, insurers can incur substantial penalties quickly. Providers can count on Allsup to provide expertise and help assist in compliance.”
Allsup can assist insurers with the process of Medicare verification, along with other Medicare related services. For more information, contact Allsup at
mirservices@allsupinc.com.
ABOUT ALLSUP
Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs more than 600 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis.
The company has helped hundreds of self-insured employers, state and municipal governments, disability and workers’ compensation insurance carriers, third-party administrators and law firms properly coordinate employee benefits and workers’ compensation plans with Social Security and Medicare. This includes Medicare Set-Aside services to protect Medicare’s interests in workers’ compensation and third party liability settlements; overpayment reimbursement services for participants with disabilities; and reverse offset services to identify workers’ compensation claims in states with SSDI-offset potential. For more information, visit
www.Allsupinc.com.