What do Medicare’s New Reporting Thresholds Mean for You in 2017?

Posted by Brian Cox on Dec 8, 2016 11:03:49 AM

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New Reporting ThresholdIn 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:

  • Liability claims the minimum threshold will drop from $1000 to $750
  • No fault and worker’s compensation claims- the $750 threshold set earlier this year will remain in effect

What do these changes mean for you?

The first key takeaway for every P&C Insurance company is that some IT housekeeping is probably in order:

Most companies have automated systems in place to identify claims that meet Medicare’s reporting requirements. Obviously, with a change in the threshold amounts, these systems will need to be updated across the board to ensure you’re still catching all the necessary claims, or you could under-report and leave yourself open to compliance flags or potential fines.

But beyond technical updates, there’s also a jump in workload to be considered:

By their very nature, Medicare-related claims that must go through the reporting and recovery process take longer for the average claims adjuster to close due to extra steps in the procedure, time spent waiting for responses from Medicare, and the fact that the adjuster doesn’t deal with these kinds of claims very often. (I know this is a link – can we change it to “everyday” or “on a consistent basis”?

With the lower threshold, there are going to be more of “these kinds of claims” than ever before. And that can turn into a training and personnel issue for large insurers processing high volumes of claims.

What can Flagship do to help?

While these threshold changes are going to boost the required workload on us as well, we’re already proactively set up to absorb that change in volume. Beyond that, the changes in threshold don’t affect how our best-in-class Medicare compliance services aid our customers.

What it does mean is that P&C Insurance companies are likely to need the help of an experienced third party to aid in handling the heavier workload and to ensure all qualifying claims are being identified and properly processed.

That’s what Flagship Services Group offers the P&C Insurance community heading into 2017. Contact us to learn more about partnering with Flagship Services Group for guaranteed Medicare compliance, or download our ebook now.

Medicare Compliance Manual, Flagship Services Group

Topics: Compliance, section 111, medicare compliance