MMSEA Reporting – What Every RRE Should Be Doing…
I have been in sales for 20 + years; eight of them spent in the Medicare Compliance industry. Much of what I know about Medicare, Medicaid and the SCHIP Extension Act (MMSEA) Reporting has been learned in the field by helping clients choose the best compliance options for their particular circumstance. I am conservative in my opinions and always try to err on the side of caution, like many of my clients.
It is surprising how Responsible Reporting Entities (RREs) are looking at the exposure represented by MMSEA reporting and how many are taking huge risks. As the required reporting deadline approached, it was evident that many RREs were not going to be ready in Quarter 1 of 2011 and an extension was a happy coincidence for them. I would not count on another chance like that in the future.
The latest round of MMSEA extensions has placed a good portion of the industry in limbo. Many RREs prepared for reporting were suddenly not required to do so for another year. This problem was compounded by the fact that many have exposure in multiple lines of insurance and were leery of bifurcating their reporting program. What are the options for reporting data for these RREs that are ready? What should you be doing as an RRE if you are not ready?
You’ve Missed the First Two MMSEA Boats; Don’t Miss This One
MMSEA reporting solutions were cheap to the market in 2009 and 2010; Mandatory Insurer Reporting (MIR) providers learned that they, for the most part, had “given” their most valuable product away and now are raising prices. The average MIR reporting solution in 2009 would have cost a client about $12,000 including the implementation fee. In 2011, you can double that cost. The point; if you have contracted for MMSEA reporting services, you are currently enjoying the lowest cost. If you are not contracted for reporting services; you should address the issue as pricing will continue to rise. Locking in your cost now will bring benefits in the future.
For those RREs that are currently prepared to report- what you are waiting for? Instead of dividing your reporting program, what valid reasons are there for not sending data to Medicare now? Common concerns brought to my attention are:
- Telling Medicare Too Much; Too soon
This will not be a concern in claims that are not settled; Medicare Secondary Payer (MSP) rights ripen at settlement and only are addressed if the claim closes through Settlement, Judgment or Award. If the claim stays open, the reporting will not affect the outcome negatively. If you report the claim early and settle, Ongoing Responsibility for Medicals (ORM) is terminated but the Total Payment Obligation to the Claimant (TPOC) amount is not reported unless you choose to send the information voluntarily.
- Medicare will come after us
If Medicare can, it will engage in rights of recovery for conditional payments but, that process cannot begin until the settlement or award is effectuated.
- Will there be penalties if we report early? What if we miss something?
Medicare has stated they will accept early reporting from all lines of insurance and that penalties will not be assessed on liability claims with No Ongoing Responsibility for Medical until 10/1/2011. So, if the RRE is reporting voluntarily and misses a claim, there is no potential for penalty, according to CMS.
If I Voluntarily Report Claims Data to Medicare Now, What Will That Mean for My Program?
Generally, early MMSEA reporting will not create any new exposure for an RRE. It allows the RRE to learn the data gathering process and integrate the reporting steps into their daily claims handling processes. There are many required steps to timely reporting that effect claims handling. Introducing these steps into your program now will create a learning environment without penalty. This opportunity to submit Mandatory Insurer Reporting data to Medicare with no potential for penalty has been presented to the industry for the last time in the form of this extension. How will you take advantage of this extension?
The required submissions for the first period for Workers Compensation and No Fault Insurance are going well for many RREs. If an RRE is not prepared or has not sent data to Medicare, the window to send that input file is closing quickly. If the reporting solution the RRE has chosen has failed or is not ready to submit, contact your EDI Representative to explain your situation. There are things that can be done to help reduce your potential exposure under MMSEA Section 111 if they are addressed early.
For Liability RREs, the MMSEA extension isn’t a favor. Medicare was unprepared to deal with several issues related to Tort claims. The extension gives time for Medicare to prepare a solution to address these issues and should allow for greater scrutiny of claims reported in 2012. Many RREs are ready to submit data and intend to do so to avoid exposure.
There is no “right” answer to the question whether to report now or wait until later. The RREs that are reporting early will have a distinct advantage over their competition. They will be able to inform their potential clients that their reporting solution works and can show that live data has transferred between the reporting agency and Medicare.
RREs that decide to wait to report are going to pay more in implementation fees and contracted reporting costs. A time crunch awaits RREs that delay their MMSEA reporting and, in all likelihood, Medicare will have penalty assessment protocols in place for those who fail to take advantage of the extension.