MMSEA Section 111: Medicare Secondary Payer Mandatory Reporting

Beginning January 1, 2010, liability insurance, including self-insurance, no-fault insurance and workers’ compensation, referred to as Responsible Reporting Entities or “RREs” are required to report settlements to Medicare pursuant to the Medicare Secondary Payer statute. The reporting will be in electronic format. Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA Section 111) adds mandatory reporting requirements with respect to Medicare beneficiaries who receive a settlement, judgment, award or other payment from liability insurance, including self-insurance, no-fault insurance, or workers’ compensation.

Medicare is the secondary payer to insurance and self-insured plans. Medicare is entitled to reimbursement for past medical expenses for injury-related care. Moreover, Federal law requires all parties to “consider Medicare’s interest” in a 3rd party settlement. This requires evaluation and set-aside money (Medicare Set-Aside) (MSA) for future injury-related Medicare medical expenses. The 45 points of data collected under Section 111 reporting will be used by CMS for MSP recovery efforts. These reporting requirements increase the likelihood Medicare will review settlements and judgments and pursue reimbursement and set-aside for future medical expenses.