CMS Issues New Section 111 Alert

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog on June 11, 2020
Posted by Jean S. Goldstein, JD, CMSP

Today, the Centers for Medicare & Medicaid Services (CMS) issued an alert which serves as a reminder that Non-Group Health Plan Responsible Reporting Entities (RREs) must include both Med Pay and PIP coverage limits for a policy when the coverages are being paid out on claims for the same injured party and incident under a single policy. CMS issued this alert because it came to their attention that some NGHP RREs have only included Med Pay when reporting the No-Fault Insurance Limit. If both Med Pay and PIP coverage limits are not reported, then the amount reported is not an accurate reflection of the policy limit. In addition, Ongoing Responsibility for Medicals should not terminate until both the Med Pay and PIP coverage limits are exhausted. CMS also noted the importance of correctly reporting the policy limits with the current decimal places when reporting a No-Fault Insurance Limit, providing the specific example of a policy limit of $5,000 (which should be reported as 500000).  

While this alert addresses only no-fault insurance limits, it is nonetheless an important reminder to make sure reporting is done accurately, which as we have seen in recent months is a central focus for CMS. You may recall that the proposed section 111 civil money penalties rule also addresses the importance of accurate information being reported.  Specifically, with the proposed rule there are error tolerance thresholds that, if exceeded, would mean civil money penalties could be levied against an RRE. In addition, penalties, per the proposed rule can be imposed when reported information contradicts conditional payment recovery efforts and responses. Again, this brief alert is a reminder to report, and report accurately.  As of today, there has been no additional movement or issuance of the final rule for civil money penalties.  

For further questions regarding this alert, mandatory insurer reporting requirements, or status of the proposed rule on civil money penalties for reporting, please feel free to reach our team at