|
 |
The premier provider of medical professional liability insurance for physicians and clinics in Washington, Oregon, and Idaho. |
|
 |
||||||||||||||||||||
| ||||||||||||||||||||||||
|
|
 |
||||||||||||||||||||||
| ||||||||||||||||||||||||
 |
|
News & Insight
CMS Requirement Imposes Strict Paid Claims Reporting Requirements
The Centers for Medicare and Medicaid Services (CMS) is a secondary payer when Medicare beneficiaries are compensated for their past and future medical expenses in liability claims. CMS, therefore, is entitled to be reimbursed for medical expenses it paid on behalf of a beneficiary who recovers those medical expenses in a liability, workers’ compensation, medical professional liability (malpractice), or no-fault claim. CMS is also entitled to take into account compensation paid for future medical expenses when determining its obligations to pay for medical expenses incurred after resolution of the case. To help CMS recover more of its funds paid on behalf of Medicare beneficiaries and to improve its management of future medical expenses that have already been paid by settlement or judgment, the Medicare, Medicaid, and SCHIP Extension Act of 2007 established reporting requirements for liability insurers (like Physicians Insurance), self-insureds, workers' compensation insurers, and others who pay claims to Medicare beneficiaries. What this means The identity of a Medicare beneficiary whose illness, injury, incident, or accident was at issue in a paid claim must be reported to CMS. Liability insurers, no-fault insurers, workers' compensation insurers, and self-insured organizations that pay such claims were expected to register with CMS as “required reporting entities” (RREs) by September 30, 2009. Due to several delays in implementing this new reporting requirement, unregistered RREs can still register with CMS. Quarterly reporting of claims paid to Medicare beneficiaries will begin during the first quarter of 2011 for all such claims settled or tried to a verdict on or after October 1, 2010. The penalty for failing to report claims and for late reports can be a fine of up to $1,000 per day per claim. While the inception of reporting has been delayed several times, it appears quite likely there will be no further delays. This reporting obligation will create an enormous data collection project for CMS. All liability payers, not just medical professional liability claim payers, will be reporting claims paid to Medicare beneficiaries. And this duty to report extends beyond insurers to include any organization or individual making such payments on their own without insurance. At the same time, all no-fault and workers’ compensation insurers will be reporting payments made to Medicare beneficiaries. Issues at hand As a medical professional liability insurer, Physicians Insurance is an RRE. We have implemented extensive system changes in order to collect and report required data in the format CMS requires. Considerable staff time has been required to parse and understand the reporting requirements, program our computers, test the system, train staff, and implement the controls needed to assure accurate and complete reporting. We are doing the data collection, testing, and additional training necessary to be ready to report fourth quarter 2010 settlements and judgments with Medicare beneficiaries. That first report is due during an assigned week in the first quarter of 2011. Recently, CMS created an alternative reporting mechanism for RREs who report fewer than 500 payments annually. Physicians Insurance qualifies for this alternative reporting mechanism, and we are evaluating whether to use it. How we stepped up to bat In tandem with the Physician Insurers Association of America (PIAA), Physicians Insurance was actively involved in commenting on CMS’s draft reporting guidelines and the various versions of what has now become, in Version 3.1, a 271-page draft User's Guide. We served on a PIAA task force that explained to CMS many of the practical issues that will delay settlements, inhibit collection of required data from understandably resistant plaintiffs, and create confusion and concerns about how CMS will use the data. There were in-person meetings between CMS and PIAA staff, and in July 2009, CMS staff held a full-day meeting with PIAA staff and PIAA member companies to review the entire reporting process. CMS continues to hold national teleconferences twice a month to provide updates and answer questions. Proposed changes While not likely to be taken up by Congress before the reporting requirement commences, House Bill 4796 has been introduced to try to streamline the reporting process and provide finality to Medicare beneficiaries and insurers required to reimburse Medicare for "conditional payments" of medical expenses. PIAA and Physicians Insurance support the bill and are making efforts to persuade the House to take a serious look at it. Stay tuned for future developments. For more information, you can explore the CMS Web site dedicated to the new reporting requirement at http://www.cms.hhs.gov/MandatoryInsRep/. If you have questions about the CMS paid claims reporting requirements, contact Gary Morse, Senior Vice President, General Counsel, and Secretary of Physicians Insurance, at (206) 343-7300, 1-800-962-1399, or gary@phyins.com.
|
|
Read about our ACCOLADES program. | ||||||||||||||||||||
| ||||||||||||||||||||||||
