Is Your Company a Responsible Reporting Entity that Has Not Registered For Section 111 Reporting?

Although it has been over 10 years since Section 111 reporting went into effect, some entities responsible for Section 111 reporting may not have registered and reported claims because they are unaware of their status as Responsible Reporting Entities. Other entities may have registered for reporting but have not reported claims over the years. Now that CMS has issued proposed regulations and is closer to asserting penalties for noncompliance, it is more critical than ever that entities responsible for Section 111 reporting register and report claims if they have not done so. There is a statutory penalty of up to $1,000.00 per day per claimant for noncompliance, which would be adjusted annually for inflation.

Responsible Reporting Entities include workers’ compensation plans, no-fault insurance, and liability insurance (including self-insurance). For Medicare’s purposes, self-insurance is defined broadly. An entity engaged in a business, trade, or profession is considered to be self-insured for Medicare’s purposes “if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part.” 42 U.S.C. § 1395y(b)(2)(A)(ii).

Generally, when an insurer is involved, the insurer is responsible for Section 111 reporting, and the insured is not responsible for reporting with respect to a deductible. However, insured entities are subject to Section 111 reporting requirements when they act without recourse to their insurance. In addition, in cases involving “re-insurance, stop loss insurance, excess insurance, umbrella insurance, guaranty funds, patient compensation funds, etc. which have responsibility beyond a certain limit,” per the CMS Section 111 User Guide, the insurer is only responsible for reporting if the insurer issues payment to the claimant or claimant’s representative, not when the insurer only reimburses the self-insured entity. When the self-insured entity issues payment to the claimant or claimant’s representative in a case involving a Medicare beneficiary, the self-insured entity is responsible for reporting. Entities with a self-insured retention and other entities that are not fully insured should be certain they are reporting when required.

Responsible Reporting Entities that have not registered for reporting and have not been reporting claims should do so as soon as possible. CMS has indicated that penalties for noncompliance will only be assessed prospectively based on information CMS receives after any final regulations are issued. CMS is currently reviewing comments that have been submitted to the Proposed Rule on Section 111 penalties and no final regulations have gone into effect yet.

For Responsible Reporting Entities with 500 or fewer reportable claims per year, CMS has a Direct Data Entry (DDE) option that allows the RRE to submit information directly to CMS online. For RREs that need to register and start reporting, DDE is the quickest option.

If you have any questions about Section 111 reporting or need to register and start reporting claims, please let us know and we will be glad to assist.