We have written previously regarding MMSEA Section 111 mandatory reporting requirements, pursuant to which companies and insurers must report to the Centers for Medicare and Medicaid Services (“CMS”) payments made in resolution of claims relating to an illness, injury or accident if the claimant receives Medicare benefits. These reporting requirements are now effective and the first quarter of Section 111 reporting is nearly complete.
During the first quarter of reporting (January 1, 2012 to March 31, 2012), payments of $100,000 or less are exempt from the Section 111 mandatory reporting requirements. However, during the second quarter, the threshold dollar exemption significantly decreases. As of April 1, 2012, payments of $50,000 or less are exempt from the mandatory reporting requirements.
Originally, Section 111 only exempted payments of $5,000 or less made prior to January 1, 2013. Since the passage of Section 111, however, CMS has experienced difficulty in implementing the mandatory reporting requirements and has repeatedly amended its regulations. On September 30, 2011, the day before Section 111 became effective, CMS once again amended its previous regulations to include more graduated dollar threshold exemptions.
Specifically, the CMS September 2011 Alert¹ advised:
- that payments of $100,000 or less made prior to March 31, 2012 are exempt from reporting;
- payments of $50,000 or less made from April 1, 2012 to June 30, 2012 are exempt from reporting;
- and payments of $25,000 or less made from July 1, 2012 to September 30, 2012 are exempt from reporting.
Thereafter, the threshold exemptions remain at their previous levels:
- payments of $5,000 or less made from October 1, 2012 to December 31, 2012 are exempt from reporting;
- payments of $2,000 or less made from January 1, 2013 to December 31, 2013 are exempt from reporting;
- and payments of $600 or less made from January 1, 2014 to December 31, 2014 are exempt from reporting.
No threshold exemption applies after December 31, 2014.
Those entities registered and prepared to report using the CMS database may still do so for exempt payments as CMS will accept optional submissions.
If you would like more information regarding MMSEA’s Reporting Requirements, please review our earlier bulletins².
¹ The September 2011 CMS Alert may be found at: https://www.cms.gov/MandatoryInsRep/Downloads/Exposur eIngImplant.pdf.
² “Additional Responsibilities for Those Liable to Medicare Beneficiaries” (https://condonlaw.com/newsletters/cbaug2009.pdf); “Section 111’s New Direct Data Entry Option for Small Reporters” (https://condonlaw.com/newsletters/cAjune2010%202.pdf); “Section 111 Mandatory Reporting Extended” (https://condonlaw.com/newsletters/cbnov2010.pdf); “CMS Increases MMSEA Section 111 Threshold Dollar Exemptions” (https://condonlaw.com/newsletters/cAoct2011.pdf).