In an "Alert" dated November 9, 2010, the Centers for Medicare and Medicaid Services (CMS) has published a revised implementation timeline applicable to liability insurance (including self-insurance) responsible reporting entities (RREs) under Section 111 of the Medicare, Medicaid and SCHIP Extension Action of 2007 (MMSEA). Specifically, the obligation to report total payment obligation to claimant (TPOC) amounts subject to the reporting requirement has been extended from the first calendar quarter of 2011 to the first calendar quarter of 2012. Moreover, under the revised implementation timeline, only TPOC amounts established on or after October 1, 2011 (instead of October 1, 2010) must be reported. Earlier reporting (i.e., reporting prior to the first calendar quarter of 2012), and reporting of TPOC amounts established prior to October 1, 2011 is now optional. CMS has also delayed the staggered phase-out of its interim threshold dollar amounts for TPOC amounts that liability insurance (including self-insurance) and workers compensation RREs must report by one year.

Mandatory reporting of ongoing responsibility for medicals (ORM) by liability insurance (including self-insurance) RREs has not been delayed. Similarly, mandatory reporting by other types of RREs (such as group health plans, no-fault insurance, and workers compensation) has not been delayed. Finally, this implementation delay does not affect liability insurance (including self insurance) RREs' status as "primary payers" under section 1862(b) of the Social Security Act.

According to CMS, this Alert will be incorporated into a forthcoming revision to CMS's MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting "User Guide" for Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers' Compensation.

In an "Alert" dated November 12, 2010, the Centers for Medicare and Medicaid Services (CMS) has published an ALERT that provides information related to a default diagnosis code that may be used under extremely limited and specified circumstances when reporting liability insurance (including self-insurance), no-fault insurance, and workers' compensation (collectively referred to as Non-Group Health Plan or NGHP) information mandated by Section 111 of the MMSEA.

As documented in Section 11.10.2 and elsewhere in the Section 111 NGHP User Guide:

"Information is to be reported for claims related to liability insurance (including self-insurance), no-fault insurance, and workers compensation where the injured party is (or was) a Medicare beneficiary and medicals are claimed and/or released or the settlement, judgment, award, or other payment has the effect of releasing medicals."
There are certain, very limited liability situations where a settlement, judgment, award or other payment releases medicals or has the effect of releasing medicals, but the type of alleged incident typically has no associated medical care and the Medicare beneficiary/Injured Party has not alleged a situation involving medical care or a physical or mental injury. This is frequently the situation with a claim for loss of consortium, an errors or omissions liability insurance claim, a directors and officers liability insurance claim, or a claim resulting from a wrongful action related to employment status action is alleged.

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