Medicare Secondary Payer Reports Deadline Moved To Jan. 1

NU Online News Service, Feb. 18, 1:05 p.m. EDT

WASHINGTON--To the relief of workers' compensation insurers and self-insured risk managers, the government has extended their deadline for reporting under the Medicare Secondary Payer Act until next year.

The reporting requirements of the Act are designed is to ensure that Medicare remains the secondary payer when a Medicare beneficiary has medical expenses that fall under the primary responsibility of a liability, no-fault or workers' comp insurance plan (including those that are self-insured).

Under the Act, Medicare can recover any conditional payments it has made that should have been paid by the primary insurance plan.

The U.S. Department of Health and Human Services announced late yesterday that it has agreed to push back the deadline for reports by primary payers from April 1, to Jan. 1, 2011.

The workers' comp industry, led by a task force chaired by officials of the American Insurance Association, had met with HHS officials to urge the delay. They argued that too many issues remain undecided for the federal government to ask workers' comp providers to start reporting the data by April 1.

"Pushing back the deadline is the right move, and I commend CMS [the Centers for Medicare and Medicaid Services] for making this decision," said Peter Foley, AIA's vice president for claims and chair of AIA's MSP Task Force.

"The insurance industry has every intention to comply with the requirements, but we want the industry's data to be put forward in the best way possible to CMS," Mr. Foley explained.

The extension will allow both insurers and CMS to address a number of unresolved issues, according to Melissa Shelk, AIA's vice president of federal affairs.

"One particular concern we have raised is the difficulty of complying with the technological and privacy requirements," Ms. Shelk said. "It is our hope that in the coming months we'll be able to fix this and other concerns so that we can move forward and start complying with these requirements."

The coalition lobbying for the implementation delay included representatives of the AIA, the Self-Insurance Institute of America and the National Association of Mutual Insurance Companies.

The decision provides "welcome relief for self-insured companies that would have experienced a significant hardship and possible financial penalties if they had unable to implement these rules so soon," said SIIA's chief operating officer, Michael Ferguson.

Mr. Ferguson said that property and casualty insurers as well as risk managers who self-insure have been working diligently for the past two years to meet the new reporting requirements.

"Given the uncertainty surrounding the reporting system and requirements, delaying the implementation of the reporting requirements is the right thing to do," said Marliss McManus, senior director of federal affairs for NAMIC.

"Without resolving these complex issues, insurers would have been unfairly subjected to significant penalties in trying to meet vague reporting requirements," she added.

NAMIC has created a special Medicare Secondary Payer Resource Center on its Web site ( to help members with registration and preparing for the reporting requirements.

The new reporting provision was mandated under the Medicare, Medicaid, and the SCHIP Extension Act of 2007.

The purpose of the reporting requirements is to ensure that Medicare remains the secondary payer when a Medicare beneficiary has medical expenses that fall under the primary responsibility of a liability, no-fault or workers' comp insurance plan (including those that are self-insured).

It also will allow Medicare to recover any conditional payments it has made that should have been paid by the primary insurance plan.

The Medicare Advocacy Recovery Coalition (MARC) applauded the delay.

"The industry has been working diligently to build an infrastructure to supply data to CMS, investing millions of dollars to ensure compliance with the data share regulation," said Roy Franco, co-chair of MARC and director of risk management services for Safeway Inc.

"Unfortunately, there have been unforeseen difficulties and unanswered questions regarding the reporting process, and everyone's ability to get the job done by April 1," he added in a statement.

An "Alert" on the delay posted by CMS allows testing to continue thru Dec. 31, 2010, and only begins live reporting on Jan. 1, 2011.

"This expansion of an additional nine months will allow time for both the Agency and the industry to navigate system roadblocks and clarify open policy issues," said Katie Fox, co-chair of MARC, as well as MSP compliance and resolution manager for MedInsights Inc.

"The claims community will continue to exchange data with Medicare in a collaborative effort to improve the data reporting systems," added Marcia Nigro, assistant vice president and complex claim consultant for Sedgwick, in the MARC statement.

MARC member organizations are comprised of entities representing attorneys, brokers, insureds, insurers, insurance and trade associations, self-insureds and third-party administrators. More information about the group is online at


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