We are living through historic times. COVID-19 may result in permanent changes including how and where we normally work; while, during this same period, the Medicare Secondary Payer (MSP) industry may see CMS finalize and publish regulations regarding how and when to calculate and impose civil monetary penalties (CMPs) upon group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) which fail to meet reporting obligations.
In this, our final of a three-part series taking a closer look at each of the key pillars in CMS’ new proposed rules for Civil Monetary Penalties (CMP). Our first two parts looked at Failing to Register and Report, Registering and Reporting, and Poor Quality of Reported Data, Poor Quality of Reported Data.
There is a season for every purpose. Are you reporting as required? Is your reporting data accurate? Do the errors matter? What is your error tolerance level today, and what are its historical tendencies? Is your data transparent and timely? When do repayment and reporting intersect? Who can reliably audit your current compliance level to determine whether you even have a reporting issue? How can our current reporting procedure undergo a risk evaluation?
In the first of a three (3) part series, we will take a closer look at each of the key pillars in the new proposed rules, starting with Failing to Register and Report. The final two (2) parts will cover Poor Quality of Reported Data, and Recovery Information Contradicting Reporting.
The Centers for Medicare and Medicaid Services (CMS) is set to release their proposed rulemaking for Civil Money Penalties (CMP’s) regarding Medicare reporting. CMS is expected to publish the proposed rule on Tuesday, February 18, 2020 and is accepting public comment for 60 days. The deadline to submit comments will be Monday, April 20, 2020. If you choose to submit comments, please reference file code CMS-6061-P.
Medicare is paid for through two Trust Fund accounts—Hospital Insurance and Supplementary Medical Insurance—held by the United States Department of Treasury, How Is Medicare Funded. In 2018, over 60 million people were covered by Medicare with over $731 billion in total expenditures from the Trust Funds Facts on Medicare Spending and Financing. Further, CMS reports validating $493.68 million in recoverable mistaken conditional payments, while returning $98.68 million dollars to the Medicare Trust Funds in 2018 as a direct result of its recovery program activities, on top of $131.78 million in 2017, MSPRC Commercial Repayment Center in Fiscal Year 2018. Collection activity by the United States Department of Treasury (DOT) on Medicare conditional payments is reportedly increasing in 2019, plus, over the past 15 months, the United States Department of Justice reached six-figure settlements with two Plaintiff’s law firms for failure to repay Medicare conditional payments.
In Dr. Seuss’ classic book, a determined baby bird is searching for his mother but does not know what she looks like. Under Medicare Secondary Payer (MSP), certain insurers encounter similar problems trying to figure out whether it is a Primary Plan with Section 111 and reimbursement obligations.
Business organizations face all kinds of risk. Developing strategic risk management plans as a business practice is becoming more prevalent across industry lines which help the organization define, measure, anticipate, and respond, for example, to foreseeable risks, technological developments, as well as changing laws and regulations. Some risk is insurable, while other kinds may necessitate capital, cost or other investment such as an organization adding new personnel or contracting with subject matter specialists or consultants. Some risk is not as perceptible as others, yet still must be handled if it occurs. Ideally, an effective risk management plan is tailored to the organization and ultimately improves its performance by avoiding, minimizing or mitigating risk.