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Member, Beacon International Group, Ltd.
WASHINGTON—The Centers for Medicare & Medicaid Services has substantially shifted its definition of a responsible reporting entity to comply with Section 111 of the Medicare, Medicaid and SCHIP Extension Act.
Insureds with deductible policies for liability and workers compensation risks no longer will meet the definition of an RRE, CMS said. For liability and workers comp policies with deductibles, insurers now are responsible for reporting Medicare-eligible claims, with some exceptions, sources said.
Employers and their third-party administrators had invested substantial sums preparing to transfer data to CMS under a previous understanding that insureds would be RREs. That all changed Thursday, sources said.
“That is a big, big deal,” said Roy Franco, director of risk management strategies for supermarket chain Safeway Inc. in Pleasanton, Calif. “It is going to cause a great deal of confusion in the industry. Just when we got used to understanding what we thought an RRE was, it got changed.”
The shift could be an administrative nightmare for property/casualty insurers underwriting large-deductible programs because they typically have not been involved in handling many of the claims, Mr. Franco said.
The threat of a $1,000-a-day penalty per claim for not meeting reporting requirements also may shift to insurers. But employers may lose some control of their claims process if insurers seek to manage the Medicare component of claims differently from protocols employers have established, Mr. Franco added.
CMS also changed certain reporting dates, Mr. Franco said. Data collection of what the CMS calls Total Payment Obligation Claims must begin Oct. 1, a delay from Jan. 1. The date for reporting what CMS calls Ongoing Responsibility for Medical data was adjusted from last July to Jan. 1.
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