Protect your interests and avoid steep fines by acting now.
Dr. Kent Takemoto / PMSI Settlement Solutions
Effective July 1, 2009, compliance with Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) mandates that liability, no-fault and workers’ compensation insurers must report claims involving a Medicare beneficiary to the Centers for Medicare and Medicaid Services (CMS). CMS has dictated that Mandatory Insurer Reporting (MIR) must be completed electronically on a quarterly basis. Non-compliance carries a steep price tag—CMS is authorized to impose fines up to $1,000 per day per claim for as long as a claim remains unreported. As of the writing of this article, CMS has mandated that responsible reporting entities (RREs) must begin submitting applicable claims data—as outlined in the current User Guide 2.0—as of the second quarter of 2010.
Adding to the initial high stakes set by the fines is the complexity of the legislation and the ever-changing compliance requirements issued through policy memorandums from CMS. Combining these factors with the global economic downturn, “business as usual” is turning into a fight for survival.
Even organizations that are ahead of the curve and have established a system to manage the new reporting requirements are likely to confront challenges as the new CMS reporting mechanism goes through fits and starts. Now is a good time to consider all the options for minimizing organizational risks and capitalizing on opportunities.
The real challenge lies in making sure that Medicare’s interests are always taken into consideration. This means that the primary payer not only has to ensure MIR compliance, but that conditional payment liens must be repaid to Medicare and future Medicare-covered medical costs must be allocated for.
In considering whether or not handling Mandatory Insurer Reporting in-house is the best approach for your organization, questions to answer include:
- Do you have the technology platform to support Mandatory Insurer Reporting requirements?
- Do you have the resources to support the additional workload MMSEA compliance-reporting requirements will create?
- Do you have the internal controls to deliver complete reporting compliance the first time and every time to avoid the onerous Medicare penalties?
- Do you have years of IT experience and time-tested client connectivity?
- Do you have years of governmental reporting experience?
The Options
Claims departments must evaluate existing technology and systems to determine if handling the reporting in-house is the best approach for their organizations. There are many factors to consider, including staff, technology, systems, operations and risk. In order to best evaluate their current situation, organizations may want to enlist outside, nonbiased consultants to stress-test their systems and people and to determine scalability. Before moving forward, it is important to assess whether or not your organization has the technology capabilities to handle CMS electronic compliance reporting requirements.
