Under current Medicare law, specifically the Medicare Secondary Payer provisions, Medicare is prohibited from making payment if payment is made or can reasonably be expected to be made by group health plans, workers’ compensation plans, liability insurance, or no-fault insurance (known as “primary plans”) when certain conditions are satisfied. In other words, Medicare is always a secondary payer to these primary plans and arrangements.
In order to help ensure that Medicare is not paying as the primary payer when some other primary plan or arrangement should be, on August 1, 2008, the Centers for Medicare & Medicaid Services (CMS) published a Supporting Statement outlining the Medicare mandatory reporting data elements under the Medicare, Medicaid, and SCHIP Extension Act of 2007. Effective January 1, 2009, group health plan insurers or third-party administrators, as well as plan administrators and fiduciaries of self-insured and self-administered group health plans, are required to submit required data elements electronically, on a quarterly basis, to help CMS identify when the group health plans are primary to Medicare. The penalty for failing to report the required data elements is $1,000 per day per person for which the data should have been submitted. Plan sponsors should request adequate assurances in writing that their insurers or third-party administrators are assuming responsibility for the data collection and reporting process, and/or should develop a written compliance plan documenting the efforts they have made to meet the new reporting standards. A copy of the Supporting Statement, which contains the required data elements, may be found at www.cpscmsa.com/Docs/CMS-10265_Part_A.pdf.
If you would like to discuss how these new requirements may affect your business, please contact one of our lawyers.
