MMSEA Compliance

February 4th, 2010

In 2007 then President George W. Bush signed into law the SCHIP (State Children’s Health Insurance Program) legislation.  Included in that legislation is section 111 which creates fines against “Primary Payers” for failing to report to Medicare (CMS) and claims where payments are made for Medicare eligible beneficiaries.  The original implementation of this was targeted for October 2009, but the time frames were moved back to a test period for January 2010 and a live date of April 1, 2010.

By now you should have registered as a Responsible Reporting Entity (RRE), unless you are in the EIA’s Primary Work Comp or General Liability programs, or in the Medical Malpractice II program, in which case the EIA is operating as the RRE on our members behalf.  Whether you are going to be responsible for reporting to CMS or have hired a reporting agent to do so for you, you should be in the testing period now, making sure that your data will properly transfer to CMS, both to verify Medicare eligibility through the query process, and to report those claims involving Medicare beneficiaries.  Once your testing is successful you will be given a seven-day reporting window each quarter to transmit your information to CMS.  Remember, failure to report all eligible claims may result in fines of up to $1,000 per day per claimant.  Contact Jack Blyskal if you have questions.