What Must Be Considered

• MMSEA Section 111

• Requirements of Conditional Payment reimbursement

• Medicare's future protection

The first two are statutory requirements.

MMSEA Section 111 reporting

MMSEA Section 111 reporting applies to all responsible reporting entities (RREs), which is basically any company that is paying on a claim involving a claimant entitled to Medicare.  CMS has required quarterly reporting of Workers' Comp cases since Jan. 1, 2010.   If an RRE fails to report claims involving Medicare-entitled people, the law calls for a $1,000 civil money penalty per day, per file with no ceiling.

In instances where it has made conditional payments, Medicare has a priority right of recovery.  Medicare is authorized to make primary payments when it is a secondary payer only if a primary payer has yet to make "or cannot be reasonably be expected to make" a prompt payment (within 120 days after receipt of the claim).  Conditional payments are named so because they are conditioned upon reimbursement to Medicare.

Services We Provide

• Preparation of MSA

• Medicare conditional payment verification

• CMS submission/negotiation 

• Training and quality control presentations (customized to meet your organization's specific needs) 

• Social Security Disability programs