The Centers for Medicare and Medicaid Services (CMS) has issued important updates to the Medicare Secondary Payer mandatory reporting requirements for non-group health plans (NGHPs) under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. CMS issued a revised NGHP User Guide, the first update since July 31, 2009, and also released three Alerts that address outstanding questions relating to the reporting requirements that apply to hospitals and captive insurers.
The revised user guide includes several significant changes. Most importantly, CMS has extended the reporting deadlines applicable to NGHPs, stating that responsible reporting entities (RREs) are not required to begin submitting reports until the first quarter of 2011. In addition, CMS has clarified that RREs only need to report one-time payments (TPOCs) that occur on or after October 1, 2010, although CMS will accept reports of TPOCs with earlier dates.
In addition to the revised user guide, CMS also issued three Alerts for NGHPs. The first Alert addresses medical write-offs and other similar unresolved questions. This Alert states that CMS has delayed until publication of further guidance reporting of certain events, including medical write-offs, risk management activity, clinical trials where the sponsor has agreed to pay for items or services related to injuries or complications, and foreign RREs. However, CMS also states that RREs should continue to identify and track these claims and payments so that they can be reported upon issuance of further guidance.
The second Alert issued by CMS clarifies NGHP RRE compliance requirements. This Alert discusses some of the basic registration, testing and reporting requirements applicable to RREs.
The third Alert issued by CMS provides information on how an entity can determine if it is an NGHP RRE. This Alert finalizes some of the draft proposed RRE language from the previously issued July 31, 2009, draft RRE definitions Alert.