Medicare Secondary Payer Section 111 Mandatory Reporting Developments

  • CMS POSTS NEW VERSION OF THE SECTION 111 NGHP USER GUIDE
  • CMS POSTS REVISED SCHEDULES REGARDING WHEN LIABILITY AND WORKERS' COMPENSATION CLAIMS HAVE TO BE REPORTED

NEW VERSION OF THE SECTION 111 NGHP USER GUIDE

The Centers for Medicare & Medicaid Services ("CMS") has posted on its website Version 3.4 of The Liability Insurance (Including Self- Insurance), No-Fault Insurance, and Workers' Compensation User Guide, which will now be the governing guide concerning the Section 111 mandatory reporting program. This new version of the User Guide is broken down into five sections "to promote easier access to the NGHP User Guide Chapters," which are: Chapter 1 - Introduction and Overview; Chapter II - Registration Procedures; Chapter III - Policy Guidance; Chapter IV - Technical Information; and Chapter V - Appendices.

NEW SCHEDULE FOR WHEN LIABILITY AND WORKERS COMPENSATION CLAIMS HAVE TO BE REPORTED

CMS has posted three new Alerts regarding revised implementation timelines and thresholds for reporting purposes:

Revised Mandatory TPOC Thresholds for Liability Insurance (Including Self-Insurance) Alert, which concerns revisions to the implementation timeline and mandatory TPOC thresholds for liability insurance (including self-insurance), and provides a schedule of the new dates and TPOC amounts. 

Revised Mandatory TPOC Thresholds for Workers' Compensation Alert, which concerns revisions to the implementation timeline and mandatory TPOC thresholds for workers' compensation, and provides a schedule of the new dates and TPOC amounts. 

Mandatory Minimum Dollar Threshold for Workers' Compensation Ongoing Responsibility for Medicals (ORM) Extended Indefinitely Alert, which provides a definition of the type of workers' compensation claim that is excluded from reporting under the program "until further notice" from CMS.