In our last issue, we reported on new stringent Medicare reporting guidelines to be imposed by the Centers for Medicare & Medicaid Services (CMS) in accordance with the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). These time-consuming and potentially costly requirements are a source of confusion for many. Therefore, it is welcome news that the CMS has delayed the start date for the mandatory report requirements associated with Section 111 of the MMSEA. The new start date for the mandatory reporting requirements is January 1, 2011.

This delay allows additional time to implement the procedures that will ultimately ensure compliance with the Act. This time should be used to set up and test the processes necessary to meet January's mandatory reporting requirements because responsible reporting entities (RREs) who fail to meet those requirements will face significant penalties of $1,000 per day for non-compliance and other possible liability. Defendants in civil matters who comply with the portion of the act concerning reporting for non-group health plans must be able to effectively determine the Medicare eligibility of plaintiffs. The information that the CMS requires to be reported is significant and can be burdensome to collect. Therefore, the information required by the CMS must be collected as soon as possible so that reporting is not delayed.

Following are some of the steps to ensure compliance:

1. If you are an RRE, complete your registration;
2. Establish and begin data collection procedures in order to determine the Medicare status in your claim;
3. Participate in a round of data exchange or testing to ensure that you or your agent is able to provide the necessary file information to the CMS;
4. If possible, begin quarterly file testing now.

Defendants and carriers should keep in mind that although the Medicare mandatory reporting requirements have been delayed, the remainder of the Act's provisions remain. The CMS continues to provide guidance through updated User Guides and bulletins to assist those who are required to report with compliance.

For details on MMSEA and the CMS's reporting requirements, please visit www.wfbm.com/newsletter.html to view our Volume 9, Issue 1 article detailing the Act.


Tina Van Dam is a partner in WFB&M's Orange office. She can be contacted at (714)634-2522, extension 3343, or tvandam@wfbm.com.

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