MMSEA 111: Are You a Responsible Reporting Entity (RRE)?

Because this is a policyholder blog, you might think this is an odd question since RREs are usually insurers or TPAs; but the fact is that most large corporate policyholders probably are RREs ― not just for worker’s comp claims, but for tort claims as well. 

MMSEA-111 [Medicare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (See 42 U.S.C. 1395y(b)(7) & (b)(8))] is designed to give the government the information it needs to collect on Medicare liens against, among other things, tort settlements and awards. For those of you who have no idea of what I’m talking about, the excruciating backstory of these rules can be found Here and Here. The government’s pathway into an abyss of Orwellian proportions can be found Here and download links Here . And, just so your attention doesn’t wander, the fines for non-compliance are $1,000 per day per claimant. 

The key passage to determining who is an RRE in the 180-page MMSEA-111 guide is found on page 56:

The key in determining whether or not reporting for 42 U.S.C. 1395y(b)(8) is required for these situations is whether or not the payment is to the injured claimant/representative of the injured claimant vs. payment being made to self-insured entity to reimburse the self-insured entity. Where payment is being made to reimburse the self-insured entity, the self-insured entity is the RRE for purposes of the payment made to the injured individual and no reporting is required by the insurer reimbursing the self-insured entity. 

Thus, if you have a self-insured retention or “indemnify,” rather than “pay on behalf of,” insurance policies, you are the RRE, not your insurers. 

Fortunately, most implementation deadlines have been delayed. However, the registration period has already begun and must be completed by Sept. 30, 2009. An impenetrable “Quick Reference Guide” to registration can be found Here.

Testing begins in the first quarter of 2010 and substantive reporting in the second quarter.

Substantive reporting, as opposed to testing, begins in the first quarter of 2010. To paint with the broadest possible brush, RREs must report claims

where the injured party is/was a Medicare beneficiary, that are addressed/resolved (or partially addressed/resolved) through a settlement, judgment, award or other payment on or after July 1, 2009

Why? Because the government wants a piece of the action. The way to get it is to require the people who pay those settlements or judgments to report every possible fact that the government can possibly imagine. 

How do you know which claims to report?

RREs must implement a procedure in their claims review process to determine whether an injured party is a Medicare beneficiary. RREs must submit either the Social Security Number (SSN) or Medicare Health Insurance Claim Number (HICN) for the injured party on all Claim Input File detail records. RREs are to report only with respect to Medicare beneficiaries (including a deceased beneficiary if the individual was deceased at the time of the settlement, judgment, award or other payment). If a reported individual cannot be identified as a Medicare beneficiary based upon the information submitted, CMS will reject the record for that individual. … It is not acceptable for an RRE to send information on every claim record without regard to the injured party’s Medicare status. CMS will monitor ongoing Claim Input File submissions to make sure that RREs have implemented a procedure to reasonably identify an injured party as a Medicare beneficiary rather than dumping their entire set of claims to satisfy Section 111 reporting requirements.

Plaintiff and defense lawyers will have to collect necessary information to satisfy the government’s appetite either formally during discovery, or informally in connection with settlement negotiations. The government is seeking more than 100 fields of data for each claim that has to be reported. 

This post just skims the surface. I see expensive consultancies lining up to help … for a small fee of course. 

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