CMS Webinar on Section 111 Reporting: Indemnity Settlements Need Not Be Reported and Other News

On August 13, 2020, CMS held a webinar on Section 111 reporting. Notably, during the Question & Answer session CMS clarified that indemnity only settlements do not need to be reported under Section 111.

In previous teleconferences CMS has given conflicting information on whether indemnity only settlements should be reported under Section 111. During the December 14, 2011, and September 18, 2012, teleconferences, CMS indicated that indemnity only settlements should be reported. In the September 21, 2011, teleconference, CMS discussed that they were considering an alert on whether indemnity only settlements should be reported, but no alert was issued. Later in the September 21, 2011, teleconference, however, CMS agreed with a caller on reporting an indemnity only settlement and described it as “appropriate.”

The User Guide does not provide specific guidance on whether indemnity only settlements should be reported. The User Guide states that “[i]nformation is to be reported for claims related to liability insurance (including self-insurance), no-fault insurance, and workers’ compensation where the injured party is (or was) a Medicare beneficiary and medicals are claimed and/or released or the settlement, judgment, award, or other payment has the effect of releasing medicals.” During the August 13, 2020, webinar, CMS pointed to this guidance from the User Guide in stating that indemnity only settlements do not need to be reported. However, a case with an indemnity only settlement involves a claim for medical benefits, and the User Guide reflects that information is to be reported when “medicals are claimed.” The User Guide provides that periodic indemnity payments are not reportable as TPOC “as long as the RRE separately assumes/continues to assume Ongoing Responsibility for Medicals (ORM) and reports this ORM appropriately,” but it does not specify whether indemnity only settlements need to be reported. Hopefully CMS will issue an alert or updated User Guide specifying that indemnity only settlements do not need to be reported.

CMS also explained during the webinar presentation that Recovery Agent information provided in the TIN reference file will apply to all recovery actions going forward. Older claims do not have to be resubmitted with Recovery Agent information. Only the TIN reference file needs to be updated.

CMS reminded RREs that multiple claim input files may be submitted during a single quarter. The two limitations are that the first claim input file must be processed before the second file is submitted and the second file cannot be submitted within 14 days of the first. CMS primarily allows RREs to submit multiple files within a quarter in order to promptly provide information on ORM and ORM termination.

CMS also discussed language that was recently added to the User Guide clarifying that the $750.00 liability TPOC reporting threshold only applies to physical trauma-based injuries and does not apply to exposure, ingestion, or implantation cases. The User Guide states that this language was added as a “reminder,” though prior versions of the User Guide did not specify that the $750.00 liability TPOC reporting threshold only applies to physical trauma-based injuries. As CMS noted during the webinar, the SMART Act amendments to the Medicare Secondary Payer Act provide that Medicare will not recover and reporting is not required for physical trauma-based injuries when the amount of a settlement, judgement, award, or other payment is below the threshold. However, prior versions of the User Guide generally reflected that the $750.00 TPOC threshold applied to liability claims, did not specify that the threshold was only applicable to physical trauma-based injuries, and indicated that reporting liability TPOC amounts of less than $750.00 is optional. Angel Pagan, the EDI Department Director, stated during the Question & Answer portion of the webinar that they have been discussing discrepancies in the User Guide with CMS but there is no concrete answer on the issue yet.

CMS reminded RREs that the amounts for med pay and PIP coverage should be combined in reporting the policy limit amount for no-fault claims. CMS had issued these instructions in an alert from June 8, 2020, which was incorporated into the current User Guide and which we discussed in our previous article at https://www.carrallisonmsa.com/post/cms-alert-regarding-reporting-of-no-fault-insurance-limits.

CMS also went over recent enhancements to the Medicare Secondary Payer Recovery Portal, which allow authorized users to view and print correspondence, see diagnosis code descriptions when hovering over codes, view diagnosis codes submitted for ORM reporting, and see additional case status information, including information about Treasury referrals.

CMS did not provide any update on when any final regulations may be issued on Section 111 penalties. However, CMS confirmed that they will hold teleconferences after any final regulations are issued.

CMS indicated that the webinar slides should be available on www.cms.gov by the end of next week. If you have any questions about Section 111 reporting, please let us know and we will be happy to help.