Trades Urge HHS To Delay Medicare Reporting Requirements

NU Online News Service, Feb. 5, 1:20 p.m. EST

Too many issues remain undecided for the federal government to ask workers' compensation providers to start reporting on April 1 under the Medicare Secondary Payer mandatory reporting requirements, insurer trade groups told the U.S. Department of Health and Human Services in a letter.

The letter was written to HHS by officials of the American Insurance Association, the National Association of Mutual Insurance Companies, and the Self-Insurance Institute of America.

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

The issues detailed in the letter include the fact that the Centers for Medicare and Medicaid Services have yet to give final guidance on some issues, such as which entity has reporting responsibility, when due to risk-sharing arrangements more than one reporting entity has a share of the settlement.

Moreover, the insurance and self-insurance industries have "serious concerns" with the mandatory requirement to submit certain data elements, including beneficiaries' Social Security numbers and heath insurance claim numbers, the groups said.

They also said that confidentiality and security of data issues have still not been addressed, and there has been an inadequate period for testing the proposed reporting system.

And with respect to enforcement, "we believe that the penalty provision of $1,000 per day, per claim, is excessive and, at the very least, should not be assessed on the first report submitted by any entity," the groups said in their letter.i

"Property-casualty insurers, as well as companies that self-insure, have been working diligently for the past two years to meet the new reporting requirements," they said, yet "despite our best efforts and those of the senior decision makers within the Centers for Medicare and Medicaid Services, the agency has yet to demonstrate that the new reporting system will properly function."

The letter added, "we are expected to begin reporting data using this system in just a matter of weeks."

Even more critical, the letter said is that, "CMS has not yet provided final reporting parameters to those insurers and self-insurers subject to the new requirements."

Since failure to comply with the reporting requirements as of April 1, "will expose insurers and self-insureds to substantial financial penalties, we believe that a more realistic implementation date is not only appropriate but also imperative," the letter notes.

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 (including self-insurance), no-fault or a workers' comp insurance plan.

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