The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 NGHP User Guide (Version 6.7, January 10, 2022) regarding non-group health plans (liability, no-fault and workers’ compensation). This updated guide replaces Version 6.6 (December 13, 2021).
As usual, CMS lists the new updates in the beginning of each User Guide chapter in a “Summary” page. Reviewing these pages indicates that updates were made Chapter IV (Technical Guidance) and Chapter V (Appendices).
Overall, as part of the new updates CMS is providing an opportunity for those Responsible Reporting Entities (RREs)[1] who have established a Medicare Secondary Recovery Portal (MSPRP)[2] account, a paperless option to obtain Medicare Recovery Correspondences by adding indicators to the associated recovery addresses within the RRE’s TIN reference file.
A general overview of the updates made by CMS as part of NGHP User Guide (Version 6.7) is as follows:
User Guide updates and changes
As part of the Chapter IV updates, CMS describes the changes as follows:
When there is an active Medicare Secondary Payer Recovery Portal (MSPRP) account for the insurer/recovery agent TIN, Section 111 submitters may set Go Paperless options (i.e., choose to receive letters electronically or by mail) for the insurer and/or recovery agent address using the TIN Reference File (Sections 6.3.1.1 and 6.3.3)[3]
CMS describes the updates made in Chapter V as follows:
When there is an active Medicare Secondary Payer Recovery Portal (MSPRP) account for the insurer/recovery agent TIN, Section 111 submitters may set Go Paperless options (i.e., choose to receive letters electronically or by mail) for the insurer and recovery agent address using the following new TIN Reference File fields (Appendix B):
- TIN/Office Code Paperless Indicator (Field 23)
Recovery Agent Paperless Indicator (Field 24
- Recovery Agent TIN (Field 25)
Note: There are also five new fields (Fields 48-52) returned for these entries on the TIN Reference Response File (Appendix D). [4]
Comments and Considerations
An insurer’s timely receipt and response to Medicare’s recovery letters is a critical aspect of addressing and resolving Medicare conditional payment claims. Up until this point, CMS has been providing these letters and notices in hard copy using the U.S. postal system. However, over the past several months, there have been reports of service delays and late delivery of CMS conditional payment notices, demands, and intent to refer to Treasury notices via the postal system which are likely related to on-going challenges associated with the global pandemic.
In light of these current issues, CMS’s new Go Paperless enhancements to the MSPRP will now allow RREs to opt out of physical mail delivery in favor of receiving an electronic notification when a new recovery letter is available for download on the MSPRP. This would seemingly provide an advantage over using the physical mail process and would appear to provide an opportunity for RREs to obtain CMS correspondence in a timely fashion and help safeguard against lost or misdirected mail.
In the bigger picture, many RREs, Recovery Agents, and other stakeholders will likely view CMS’s new paperless option as a welcomed and helpful enhancement to their current process to address and resolve CMS conditional payment claims in a timely manner.
How we can help
For those RREs interested in learning how they may leverage CMS’s new paperless option regarding Medicare recovery letters, please let us know and we would be more than happy to assist with reviewing your processes to help determine how CMS’s new option could help improve your current practices.
Questions?
Please contact the authors if you have any questions regarding CMS’s updates or other issues related to Section 111 reporting or Medicare’s conditional payment process.
[1] Responsible Reporting Entities (RREs) are the parties who are obligated to report under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173). While Section 111 applies to both group health plans (GHP) and non-group health plans (NGHP) (i.e. workers’ compensation, liability, self-insurance, and no-fault insurance), references to Section 111 in this article relate to Section 111 reporting in the NGHP context as codified at 42 § U.S.C. 1395y(b)(8). In general, RREs are insurers and self-insurers, but could involve other entities such as self-insurance pools or assigned claims funds depending on the facts. (See generally, CMS’s Section 111 NGHP User Guide, Chapter III (Version 6.5, October 4, 2021), Chapter 6. Expanding on this concept further, 42 U.S.C. § 1395y(b)(8) provides that the “applicable plan” is the RRE and defines the term “applicable plan” to include liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans.) However, claimants and their lawyers are not RREs and do not have reporting responsibilities under Section 111. Id.
[2] CMS describes its MSPRP as follows: “The Medicare Secondary Payer Recovery Portal (MSPRP) is a web-based tool designed to assist in the resolution of liability insurance, no-fault insurance, and workers' compensation Medicare recovery cases. The MSPRP gives you the ability to access and update certain case specific information online.” In addition, CMS notes that it “has made available a curriculum of computer-based training (CBT) courses for the MSPRP.” See, https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/MSPRP/Medicare-Secondary-Payer-Recovery-Portal
[3] CMS’s Section 111 NGHPUser Guide, Chapter IV (Version 6.7, January 10, 2022), Chapter 1.
[4] CMS’s Section 111 NGHP User Guide, Chapter V (Version 6.6, January 10, 2022), Chapter 1.
