October 7, 2011
By: John F. Mullen and Jeannie Park
This article is an interpretation of current law and is offered for informational purposes only. This material is not legal advice and should not be construed or used as a substitute for the advice of an attorney.
On September 30, 2011, the Centers for Medicare & Medicaid Services (CMS) announced that Section 111 reporting for certain liability cases will be delayed once more. Whether or not Section 111 reporting will be delayed will require a case-by-case analysis of the Total Payment Obligation to Claimant (TPOC). Specifically, all cases with a TPOC in excess of $100,000 and a TPOC date of October 1, 2011, will continue to abide by the existing reporting deadline. However, cases with a TPOC amount of less than $100,000 will receive yet another reporting reprieve of up to one year as outlined below.
|
TPOC Amount |
TPOC Date On or After |
Section 111 Reporting Required in the Quarter Beginning |
|
TPOCs over $100,000 |
October 1, 2011 |
January 1, 2012 |
|
$50,000 to $99,999 |
April 1, 2012 |
July 1, 2012 |
|
$25,001 to $49,999 |
July 1, 2012 |
October 1, 2012 |
|
$5,000 to $25,000 |
October 1, 2012 |
January 1, 2013 |
The latest delay to Section 111 reporting is among a string of expected changes that CMS will make to the MMSEA protocol to address concerns related to efficiency and cost effectiveness. For example, CMS recently stated that it will not pursue a recovery claim in cases where the injury occurred prior to December 5, 1980 - as long as it is a post-1980 injury (or exposure to injurious conditions) is not alleged or released.
CMS is also expected to work on the following changes to streamline the MMSEA reporting protocols:
(1) create a self-service information feature to its telephone line to give up-to-date Demand and Conditional Payment amounts;
(2) create a web portal for claimants to obtain information as well as to provide information regarding disputed claims and/or settlements;
(3) implement an option to pay CMS immediately for future medical costs that are released in settlement; and
(4) implement a process to provide Medicare's conditional payment amount prior to settlement under certain (as yet undisclosed) conditions.
If all of these processes are ultimately put in place by CMS, the carriers will have more tools at their disposal to ensure compliance with the MMSEA and MSP protocols. In the meantime, and despite the delays in some reporting deadlines, carriers should continue as though all claims with Medicare-eligible claimants are reportable. This is largely due to the fact that the settlement/judgment range of a claim is not accurately predictable until final resolution.
