Notice to our policyholders, agents and other business partners**:
Re: SECTION 111 OF THE MEDICARE, MEDICAID & SCHIP EXTENSION ACT
FORT WAYNE, IN – July 9, 2009 – The Medical Protective Company (“MedPro”) has received numerous inquiries regarding our compliance with the reporting requirements mandated by section 111 of the Medicare, Medicaid & SCHIP Extension Act (“MMSEA”). Section 111 requires that liability insurers, self-insureds and non-group health plans making payments to Medicare recipients report those payments to the Center for Medicare Services (“CMS”) in an electronic format prescribed by CMS. Please rest assured that MedPro is fully aware of the requirements of section 111, and has assembled a team of attorneys, information technology specialists and claims personnel to manage all aspects of compliance and reporting, including: (1) the registration of responsible reporting entities; (2) the registration of account managers, (3) the performance of all required computer testing; (4) the forwarding of query files; and (5) the reporting of total payment obligations to claimants (“TPOC”) as defined by section 111.
As per the mandates of section 111, and recognizing that the critical dates have and may continue to change pursuant to CMS directives, MedPro will register its responsible reporting entities and account managers before the deadline of September 30, 2009, and will also conduct all mandatory computer testing by the end of this year. Reporting as per MMSEA’s requirements will commence on or after April 1, 2010 for all reportable TPOCs occurring on or after January 1, 2010. At this time, MedPro does not have, or anticipate having, any reportable ongoing responsibility for medical payments (“ORM”), and thus does not anticipate having any obligation to report ORM occurring on or after July 1, 2009.
In short, if you are (or you represent) a MedPro insured with a deductible or whose policy pays the first dollar on any claim with no deductible, MedPro is the responsible reporting entity and will timely report the payment of claims to CMS in accordance with section 111’s mandates.
**However, please note that reporting requirements under Section 111 are quite different where a policy is issued with a self-insured retention (“SIR”) rather than a deductible. In the event that your policy has an SIR, section 111 mandates that the self-insured entity, rather than the insurer, is directly responsible for reporting to CMS any payments made to claimants within the SIR layer of coverage. If you have questions or concerns regarding a MedPro policy with an SIR, please contact Lucy Hensleigh, Counsel for MedPro, at (260) 486-0488.
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