CMS Releases Updated Section 111 NGHP User Guide; Still No Word On Civil Money Penalties

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on October 16, 2019
Posted by Jean S. Goldstein, JD, CMSP

Many of us in the industry continue to wait with bated breath for information related to a proposed rule for Civil Money Penalties for Medicare Secondary Payer (MSP) Reporting.  You may recall our recent blog postings announcing an advanced notice of a proposed rule involving MSP reporting, and a subsequent update to the notice, which would address obsolete regulations and propose criteria and practices for which money penalties would and would not be imposed under the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).  The SMART Act brought about several pivotal changes to MSP compliance, with one significant change being to offer CMS discretion when imposing, “a civil money penalty of up to $1,000 for each day of noncompliance with respect to each claimant.” Penalties were previously legislated as being mandatory for noncompliance.   To date, CMS has never levied any of these money penalties; however, we have been on heightened alert that guidance and a hyper focus on reporting was forthcoming since the notice of proposed rule making was issued last Fall.   While, the updated notice indicated that the due date for the proposed rule is this month, we have yet to see any formal proposals.  In the meantime, CMS has released an updated MMSEA Section 111 NGHP User Guide.  The updates to the guide are minor, with only substantial changes in Chapter V: Appendices, wherein the excluded and no-fault excluded ICD-10 diagnosis codes have been updated for FY 2020 (found in Appendix I and Appendix J). 

Overall, we continue to await any formal proposal with respect to civil money penalties.  We will be certain to advise our readers once a notice has been released, particularly because industry stakeholders will likely have an opportunity to submit comments and responses to any proposal.