ExamWorks Clinical Solutions welcomes you to our Chronicle. In these brief articles, we will cover the ins and outs of all things related to Medicare Secondary Payer, MMSEA Section 111 Reporting, and Case Management. Our articles will uncover basic concepts and then move through the many nuances involved, helping you navigate the oftentimes complicated regulations and processes. In addition, our subject matter experts will be addressing and sharing FAQs and lessons learned.
Who has to report?
CMS requires non-group health insurance plans (NGHP) to participate in MMSEA Section 111 Reporting. This includes:
- Liability insurance (including self-insurance).
- No-fault insurance.
- Workers' compensation insurance.
These carriers, self-insured companies, risk pools, state funds, etc. are classified as Responsible Reporting Entities (RRE).
What is an RRE ID and how do I get one?
A Responsible Reporting Entity Identification Number (RRE ID) is assigned by CMS during the registration process. This RRE ID is referenced in the Medicare Query and Claim Reporting processes to identify your company or program to CMS.
The RRE registration process can be complicated, and requires collaboration with upper management, claims managers and information technology staff. Questions in need of answering include:
- Who will fulfil the role of Authorized Representative?
- Who will function as the Account Manager?
- How will the claims be reported to CMS?
- Will a vendor assist in the claims analysis and reporting process?
The RRE registration process can be cumbersome and may take upwards of two (2) weeks to complete. It includes the receipt of a physical letter from CMS, along with the completion of an online form.
MMSEA Section 111 Reporting is complex and requires coordination between claims operations, IT departments and executive leadership. Substantial issues can arise if reporting falls short both internally (in the form of inefficiency and added cost) and externally (in the form of possible civil money penalties of up to $1,000 per day per claim). If your organization is involved with claims having a medical component, whether directly responsible or not, you may be required to participate in MMSEA Section 111 Reporting. If you have any questions about the reporting process or need assistance determining if you have an obligation to report, please contact us at MIRService.Support@examworks-cs.com.
Stay tuned for the next installment.