The Centers for Medicare & Medicaid Services (CMS) announced the reporting thresholds for Liability, No Fault and Workers Compensation claims for 2017. Section 1862(b) of The SMART Act requires CMS to review its costs related to recovering conditional payments compared to recovery amounts annually.
The threshold for physical trauma-based liability insurance settlements will be reduced to $750. The threshold for No Fault and Workers’ Compensation settlements will remain at the $750 set earlier this fall.
This $750 threshold is for reporting TPOCs related to Liability, No Fault and Workers’ Compensation claims and does not apply to claims for which the entity has accepted Ongoing Responsibility for Medicals (ORM). Claims involving ORM are still reportable according to CMS’ current ORM reporting requirements.
The CMS alert can be read here.
More information on how CMS calculated the new thresholds can be found here.
It is important that claims executives and claims adjusters make note of these types of changes so that they can maintain compliance with Mandatory Insurer Reporting (MIR) regulations and regardless of thresholds, should you receive any communication from CMS, it is important to address it in a timely manner to avoid interest or referral to the Department of Treasury.
If you have questions about MIR, thresholds, or Conditional Payment Resolution, feel free to contact Flagship Services Group.