Jessica Silinsky, an attorney in the Birmingham office of Carr Allison, notes three important points about the new reporting requirements:

•Only claims involving Medicare beneficiaries must be reported

•Huge penalties for non-compliance - $1,000 per day, per claimant. Since the reporting is quarterly, an employer who misses a deadline for reporting a claim could potentially face as much as $90,000 in fines because of one missed deadline.

•Responsible Reporting Entities (RREs) should do their homework.

“Medicare will now be able to identify parties from which it can recover and, therefore, Responsible Reporting Entities should expect to receive conditional ayment letters. It is important to begin the conditional payment claim research as early as possible in order to consider that amount in the parties’ settlement negotiations,” she adds.

Ms. Silinsky spoke on the subject at the recently held General Membership Meeting of the South Carolina Self-Insurers Association, Inc. She emphasized that in ontracting with companies to handle the reporting to Medicare, RREs should be aware they are also binding themselves to contracts that will allow the companies to do MSAs in cases that do not warrant them.

“These agreements will likely result in high allocations that may unnecessarily hinder or prevent settlements. RREs should read those contracts carefully and strike language which would allow the company to prepare a Medicare Set-aside allocation report in any case that fits within the company’s defined guidelines,” she advises.

Ms. Silinsky notes there is some confusion among employers and others over Medicare’s new reporting requirements and the agency’s guidelines for Medicare Setasides. The reporting requirements are an entirely separate issue from the requirement to protect Medicare’s interests with regard to future medical treatment,” she points out.

Another misconception concerns what triggers reporting. For claims involving ongoing responsibility for medicals, an RRE must report to Medicare when it has assumed responsibility for medical care, and not upon or after the first payment for medical care, she says. Reporting is required for claims involving a Medicare beneficiary if ongoing responsibility for medicals was assumed on or after July 1, 2009.

“Also, the other category of claims that must be reported involve the so-called Total Payment Obligation to the Claimant (TPOC) without regard to ongoing medical services. Subject to certain exceptions and thresholds, all claims involving a Medicare beneficiary with a TPOC date of January 1, 2010 or subsequent, must be reported,” she adds.

Although Medicare has been the secondary payer to other insurance for many years, the agency had been handicapped until recently because it did not have all he information needed to track potential payers. With an estimated 80 million or so baby boomers soon expected to be eligible for Medicare, the agency is determined to mprove what in effect had been a “pay and chase” policy.