On May 25, 2010, the Centers for Medicare and Medicaid Services (CMS) published an Alert establishing a Medicare Secondary Payer reporting option that may facilitate the process for certain liability insurers and other non-group health plans (NGHPs), particularly self-insured hospitals and captive insurers. The Alert outlines a new Direct Data Entry (DDE) option for reporting settlements, judgments, awards and other payments with Medicare beneficiaries mandated under Section 111 of the Medicare, Medicare and SCHIP Extension Act of 2007 (MMSEA), codified at 42 U.S.C. § 1395y(b)(7) and (8). The new DDE option permits certain NGHPs to report claim reports online directly to the Section 111 Coordination of Benefits Secure website.
To qualify for the DDE option, the NGHP must be a “small reporter,” which is defined as a Responsible Reporting Entity (RRE) that intends to submit 500 or fewer NGHP claim reports per calendar year. NGHPs using DDE cannot use the query function to determine whether an injured party is a Medicare beneficiary. Instead, injured party information will be matched in real time as it is entered into the secure website, and each entry, even if no match is made, is counted toward the 500 claim per calendar year limit. No testing will be required for DDE, but qualifying small reporters must register for DDE on or after October 1, 2010, if newly registering, or October 4, 2010, if the small reporter has previously registered and elected to use a separate file transmission method. Once DDE has been selected, reporting may begin on January 3, 2011.
Previously, CMS had provided for submissions through HTTPS, SFTP or Connect:Direct, all of which require submission of quarterly reports during an assigned seven-day window and provided access to a query function to verify Medicare beneficiary status. With DDE, the query function will not be available. Moreover, there will be no assigned window for reporting claims. Claims are instead submitted on a real time basis, one report at a time, and must be submitted within 45 calendar days of the Total Payment Obligation to the Claimant (TPOC) or assumption or termination of Ongoing Responsibility for Medicals (ORM). There is an exception to the 45 day requirement for those TPOC and ORM payments where retroactive reporting is required (i.e., TPOC from October 1, 2010, to December 31, 2010, and ORM assumed prior to January 1, 2010, that continues to exist on or after January 1, 2010); such reports must be submitted within the first calendar quarter of 2011.