Client Advisory Update 5/11/09: Update on MMSEA Procedural Changes

Posted by John Cattie

On May 11, 2009, the Centers for Medicare and Medicaid Services (“CMS”) posted an alert (the “Alert”) on its website related to the pending implementation of Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (the “MMSEA”). The Alert provides updated reporting guidance to all liability insurance (including self-insurance), no-fault insurance and workers’ compensation responsible reporting entities (“RREs”). The Alert details several procedural changes to MMSEA implementation since publication of the User Guide on March 16, 2009. Those changes are as follows:

1. Extension of Registration Period. The registration period for non-Group Health Plan RREs, previously scheduled to end on June 30, 2009, has been extended through September 30, 2009.

2. Submission of Live Production Files. RREs are now required to submit its first live production files no later than its assigned window in Q2 2010 (April – June) instead of Q1 2010 (January – March).

3. Testing Period. The testing period for the submission of Claim Input Files will take place from January 1, 2010 through March 31, 2010. Previously, this period was to last from July 1, 2009 through December 31, 2009.

4. Early Submission. If an RRE completes the registration process and completes testing successfully prior to its assigned submission window, it may begin submitting live production files starting January 1, 2010.

5. Query Files. Query files may be submitted starting on July 1, 2009, but only if the RRE has completed registration and is in testing status according to CMS standards.

6. TPOC Reporting Exception. A Total Payment Obligation to the Claimant (“TPOC”) does not have to be reported if the settlement occurs between July 1, 2009 and December 31, 2009.

7. ORM Reporting. Reporting related to Ongoing Responsibility for Medicals (“ORM”) must still be reported if it occurs on or after July 1, 2009, but should be reported according to the revised time periods provided in the Alert.

8. Multiple TPOCs. If there are multiple TPOCs present, only those occurring on or after January 1, 2010 should be reported.

In light of the Alert, the revised MMSEA implementation timeline looks like this:
• May 1, 2009 – Sept. 30, 2009: Registration
• July 1, 2009: Test/Production Query Input Files Accepted
• January 1, 2010: Claim Input File Testing Begins
• January 1, 2010: Production Claim Input Files Accepted
• April 1, 2010 – June 30, 2010: Initial Production Claim Input Files Due

We view these changes as a positive development for RREs to have the necessary time to comply with Section 111 reporting rules. Given these changes, however, we would expect CMS to put a premium on proper reporting once live production files are mandated.

To view the Alert, please click here.