CMS Update: User Meetings, GAO Report, and Recertification Requirement

By John Giknis August 1, 2012

Here are updates on some topics you should know about if your company is required to report bodily injury claims to the Centers for Medicare and Medicaid Services (CMS).

 Medicare Secondary Payer Reporting Service User Meeting

On June 20, 2012, ISO ClaimSearch® held its fourth user meeting for participants in the ISO Medicare Secondary Payer Reporting Service. In a day-long session, we addressed ISO ClaimSearch and Medicare Section 111 reporting issues. Representatives from Verisk’s Crowe Paradis Services Corporation were on hand to discuss conditional payment reporting and Medicare Set Asides for workers' comp and liability claims. The next user meeting will be September 25 in Atlanta, Georgia.  

GAO Report

The U.S. Government Accountability Office (GAO) recently released a report on the Medicare Secondary Payer program. The report addresses the challenges insurers face in obtaining claimant Social Security numbers, the complexity of reporting correct ICD-9 codes, and the possible relaxation of the requirement for such reporting. Thresholds for liability claim reporting continue to be an issue, so the report recommends further analysis of the topic. Get the GAO report online.>>

RRE Recertification Requirement

CMS implemented a recertification requirement for all responsible reporting entities (RREs). Every year, the authorized representative of each RRE must certify information found on the CMS profile. The schedule for recertification is based on the original registration date. CMS requires insurers to respond within 30 days of receiving the recertification request. Failure to respond will result in discontinued status for the RRE. CMS won’t process any quarterly report files until the RRE recertifies the profile information. You should confirm that CMS has accepted your recertified profile.

For more information, send e-mail to claimsearchmsp@iso.com.


John Giknis

John Giknis, CPCU, SCLA, RPA, AIC, retired from Verisk in 2012. As ISO’s assistant vice president for ISO ClaimSearch Operations, he was responsible for the business operations of ISO ClaimSearch, the property/casualty insurance industry’s all-claim database.