How Will Mandatory Reporting Be Affected by CMS’ Announcements Regarding Thresholds?

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on December 13, 2016 | Posted by Jean S. Goldstein, JD

CMS recently announced a change in the reporting thresholds to $750 for liability settlements, and advised that it would maintain the $750 threshold for no-fault and workers’ compensation settlements, where the insurer or entity does not otherwise have ongoing responsibility for medicals (ORM).  Just yesterday, CMS issued a technical alert regarding the change in reporting thresholds, which can be found here.

As we head into 2017, we wanted to clarify CMS’ numerous alerts and announcements, as best summarized below:

  • For Liability Insurance Cases: The mandatory reporting threshold for total payment obligation to the claimant (TPOC) after January 1, 2017, has changed from $1,000 to $750.
    • Takeaway: If the most recent TPOC date is after January 1, 2017 and the cumulative TPOC amount is greater than $750, the TPOC must be reported.
  • For No fault Insurance Cases: The mandatory reporting threshold for TPOC amounts dated October 1, 2016 or after, changed from $0 to $750.
    • Takeaway: If the most recent TPOC date is after October 1, 2016 and the cumulative TPOC amount is greater than $750, the TPOC must be reported.
  • For Workers’ Compensation Cases:  The mandatory reporting threshold for TPOC amounts dated October 1, 2016 or after changed from $300 to $750.
    • Takeaway: If the most recent TPOC date is after October 1, 2016, and the cumulative TPOC is greater than $750, the TPOC must be reported.

Another change for 2017 is that reporting for cases below the required reporting threshold will be accepted, but are not required. CMS’ recent alert also states that until January 1, 2017, cases with amounts less than the required reporting threshold will be rejected unless reported with ORM.  After January 1, 2017, cases will only be rejected if the case is noted as having no ORM, and for which the total TPOC amount is $0.

CMS’ changes and clarification in reporting thresholds mean that an RRE is not required to report the settlement if the total TPOC amount does not fall within one of the above; nor will CMS seek recovery on cases that do not fall within the thresholds.

For more information on mandatory reporting or how the reporting thresholds will affect resolution of your case, please contact us at info@medval.com.