Responsible Reporting Entity (RRE)

7/1/2020 - 2 min read

CMS releases new NGHP Section 111 User Guide (Version 5.9)

CMS has released an updated Section 111 NGHP User Guide (Version 5.9, June 29, 2020) regarding non-group health plans (liability, no-fault and workers’ compensation).

6/16/2020 - 9 min read

Key changes to Michigan PIP start July 1, 2020 – Medicare Secondary Payer compliance impact

While individuals will still be able to elect unlimited PIP coverage, for applicable policies issued or renewed after 7/1/20, PIP plans with different coverage limits may also now be purchased.

6/12/2020 - 2 min read

CMS releases Section 111 alert regarding the reporting of no-fault insurance and med-pay policy limits on claim input files

Limits on NGHP claim input files in situations where separate Med-Pay and PIP coverages being paid out under a single policy for the same injured party and incident.

5/1/2020 - 19 min read

Court finds state of Rhode Island compliant with Section 111 despite its inability to obtain social security information to determine Medicare status and enforces settlement

The U.S. District Court in Ruiz v. Rhode Island was called upon to address whether a personal injury settlement should be enforced even though the defendant was unable to obtain the plaintiff’s social security number, or the last five digits of his SSN, to determine his Medicare status through CMS’s Section 111 Query Process.

4/21/2020 - 8 min read

CMS’s Section 111 civil money penalties comment period closes

With the comment period closed, the focus now turns to when CMS will issue its Final Rule, which will comprise of the agency’s official CMP regulations.

4/9/2020 - 1 min read

Medicare enables COVID-19 ICD-10 code for Section 111 reporting

The CDC issued a bulletin advising it is implementing the new ICD-10 U07.1 for “COVID-19, virus identified” in an off-cycle update effective 4/1/20, to code the COVID-19 diagnosis.

2/18/2020 - 12 min read

CMS’s Section 111 penalty proposals are here

CMS has released its long-awaited Section 111 civil money penalty proposals for non-group health plans, as well as group health plans.

11/20/2019 - 4 min read

CMS’s new Section 111 alert addresses MBI reporting

CMS has issued an updated Section 111 Alert pertaining to non-group health claims (NGHP) regarding the Medicare Beneficiary Identifier (MBI) reporting.

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7/15/2019 - 1 min read

CMS releases new NGHP Section 111 user guide (Version 5.6)

On 7/1/19, CMS released an updated Section 111 User Guide (Version 5.6) regarding non-group health plans (liability, no-fault and workers’ compensation).

6/27/2019 - 4 min read

Think about your thresholds: Preventing errors to avoid CMS penalties

One way responsible reporting entities can attempt to achieve full CMS compliance and avoid potential penalties is to closely consider file thresholds.

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6/17/2019 - 6 min read

Big reforms are coming to Michigan PIP - How the changes will impact Medicare Secondary Payer compliance

On 5/30/19, Governor Gretchen Whitmer signed Michigan Senate Bill 1, which makes significant changes to Michigan’s personal injury protection (PIP) system.

6/14/2019 - 6 min read

Avoiding penalty problems by ensuring data accuracy

With CMS (Centers for Medicare and Medicaid Services) penalties on the horizon, we’ve been exploring how RREs (Responsible Reporting Entities) can be proactive in avoiding fines.

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5/31/2019 - 4 min read

To avoid CMS penalty exposure time is of the essence

The timely reporting of ORM and TPOC data to CMS is of key importance to insurers, especially now enforcement of noncompliance penalties is on the horizon.

2/28/2018 - 7 min read

Medicare watch list: Staying ahead of the Medicare Secondary Payer compliance curve

As another new year settles in, we know at least one thing is certain: MSP compliance will continue to present formidable challenges for claims payers.

12/21/2017 - 3 min read

CMS Releases New Section 111 NGHP User Guide (Version 5.3)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 non-group health plan (NGHP) User Guide (Version 5.3, December 15, 2017).