CMS Delays MMSEA Implementation for Liability TPOCs for 3rd Time

Medicare Set-Aside Blog on November 15, 2010 | Posted by


Despite all beliefs that they were serious this time, in the October 28th town hall teleconference, Barbara Write indicated that the voluminous requests to delay reporting were under consideration. Given the many unanswered questions with regard to liability insurance situations and the total lack of policy development as to assessment of fines for noncompliance, these industry concerns were understandable yet expected to fall upon deaf ears. However to our surprise, CMS just announced the latest delay of the implementation of MMSEA Section 111 reporting for liability TPOCs with no ORM until January 1, 2012.



Under the new policy, liability TPOCs as of October 1, 2011 shall be reported in first quarter 2012. All liability settlement data tracked since October 1, 2010 can be disregarded, unless of course an RRE wishes to voluntarily report liability TPOC information during their assigned file submission timeframe prior to the new implementation date, as it will be accepted. Early reporting is both “welcomed and encouraged,” and specifically noted to not generate a penalty and to be viewed as an opportunity to refine the reporting process prior to the new required reporting date.

Note that this change applies ONLY to liability TPOCs. All reporting date requirements for workers’ compensation and no-fault TPOCs and all NGHP ORM remain the same. However, work comp shall benefit from the extended interim dollar thresholds which were all pushed back a year. Work comp ORM that meets all the criteria for med-only claims are excluded from reporting through December 31, 2012. Liability and work comp TPOCs up to $5,000 are excluded through December 31, 2012, up to $2,000 through December 31, 2013, and up to $600 excluded through December 31, 2014. As of January 1, 2015, there will be no threshold and all claims involving Medicare beneficiaries must be reported.

What does this all mean from an industry standpoint? For those with their heads in the sand, they may elect to stay there for another year. We continued to receive those calls daily through September 31, 2010, where people believe that so long as their claims were settled by the last deadline of October 1, 2010, that Medicare’s interests were of no concern. We continue to believe that such a position would be ill advised, as what could be the intent of the federal government in collecting such data if not to enforce its MSP rights, both as to past and future medical payments. Disregarding those rights and gambling on Medicare’s Pay and chase proving unfruitful is far more risky than taking any legal position as to its MSP rights within your claim and setting up defenses to future challenges. But to each his own and CMS has just guaranteed us another year of entertainment and speculation as what is yet to come.