In 2017, new thresholds will be applied to the Section 111 reporting requirements for liability, no fault, and worker’s compensation claims. In a nutshell, here are the changes you need to be aware of:
If your goal is 100% Medicare Compliance, then Reporting and Recovery need to go hand in hand as the Dynamic Duo of your claims process.
On September 26, 2016, the Centers for Medicare and Medicaid Services (CMS) Financial Services Group (FSG) published its latest Alert announcing the "Computation of 2016 Recovery and Reporting Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards or Other Payments."
Topics: section 111
In practice, Medicare compliance can be very complex. However, Flagship can mitigate your risk, ensure compliance and simply the process.
The first step to 100% compliance is accurate Section 111 Reporting. Every single time a new claim is initiated, the claims adjuster should ask:
- Is the claimant a Medicare beneficiary?
- Has claimant sustained an injury?
- Has or will money change hands?
If the answer to all these questions is “yes,” then you are legally required to report the claim to Medicare via Section 111.
In the past, the two main components of Medicare compliance - reporting and recovery - were separate from one another. While they’ve always been directly related, they have not actually connected in any meaningful way.
To legally remain in compliance, every P&C insurance company is responsible for both Reporting and Recovery. Medicare expects all Responsible Reporting Entities to:
We routinely preach the importance of making sure you’re 100% Medicare compliant if you’re doing business in the P&C insurance realm.