CMS Issues Alert Maintaining $750.00 Threshold for 2021

This week CMS issued an alert confirming that they will maintain the current $750.00 TPOC reporting threshold for 2021. Physical trauma-based liability TPOC amounts of $750.00 or less do not have to be reported to CMS, and workers’ compensation and no-fault TPOC amounts of $750.00 or less do not have to be reported when the RRE does not otherwise have ongoing responsibility for medicals. CMS will also not seek recovery for such cases.

As a reminder, the $750.00 threshold does not apply to liability cases involving alleged ingestion, implantation, or exposure. TPOCs of any amount are reportable for such cases. Additionally, it is important to keep in mind that CMS looks at the cumulative TPOC amount in determining whether the $750.00 threshold is met. This means that a claim is reportable if an RRE has multiple TPOCs that together exceed the $750.00 threshold.

Please let us know if you have any questions about Section 111 reporting. We will be happy to assist.