MedicareTeleconferenceSummaries08-09

Medicare Teleconference Summaries

July 27, 2009

While CMS provides you with opportunities to participate in their electronic "town halls," and provides you with TRANSCRIPTS from those town halls at the CMS website (click HERE for a link to the transcript page), both UWC (Foundation for Unemployment and Workers' Compensation) and WSIA will attempt to provide periodic summaries from the teleconferences.

Do not take these unedited notes as comprehensive summaries,

but as supplemental to your participation on the conference calls

and your reading of the town hall transcripts!

UWC's Conference Call Notes

January 22, 2009 - Town Hall Conference Call:

The Centers for Medicare and Medicaid conducted a teleconference this afternoon to provide an update on answers to questions about the new reporting requirements imposed under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007.

The session began with a series of CMS statements, including:

1. CMS has obtained legal authorization to permit Responsible Reporting Entities (RREs) to submit inquiries into the CMS system for the purpose of determining whether an individual is Medicare eligible before reporting a WC settlement, award, judgment or payment. RREs are not required to report individuals who are not verified as Medicare eligible. The queries may be made on a monthly basis. In order to submit a query the RRE must have the SSN or HICN, name, Date of Birth, and gender of the individual. If there is a match the RRE will be provided with the applicable Health Insurance Claim Number (HICN) to be used in future reporting. The query function also permits RREs to submit three of the four elements and receive the verified fourth element back with verification. If the information is not totally correct CMS will correct it using SSA data. Any disputes with respect to the SSNs of individuals are between SSA and the individual. This query function has been in place for some time and is compliant with HIPAA requirements. The query function will be available to be used with real data from the RRE beginning July 1, 2009 after the RRE completes registration.

2. The Non Health Group User Guide is scheduled to be available next month (February 2009)

3. CMS is still looking at the use of codes other than the WCIO codes for reporting (NCCI for example)

4. CMS is scheduling a meeting with the US Department of Labor to discuss reporting for funds administered by USDOL

5. CMS is scheduling meetings to discuss how to handle mass tort cases

6. CMS is considering whether to hold meetings to discuss WC separately from Liability after the User Guide is completed in February

7. Reporting entities outside the US are not excluded from the reporting requirements

8. No lines of insurance are excepted from the Section 111 reporting requirements

9. CMS is reviewing how to handle cases of joint power of authority

10. Total settlement payments with no ongoing obligation that were made prior to July 1, 2009 are not required to be reported

11. Cases where there is on-going responsibility on and after July 1, 2009 must be reported even if closed for purposes of WC settlement. CMS is looking at how far back to go in identifying cases that were closed under WC law when there is ongoing obligation.

12. CMS is looking at thresholds under which reports would not be required.

13. The RRE may designate an employee or a TPA as its authorized representative for purposes reporting. The Authorized representative will serve as the account manager or may identify an agent to serve as the account manager for the RRE. The authorized representative of the RRE may also identify account designees that may review the information and upload or transfer file information

14. CMS is reviewing how to determine the RRE where there are mergers, acquisitions or bankruptcies

15. CMS is reviewing how to handle the obligation to report guest workers or documented aliens who subsequently become citizens

16. Undocumented and illegal aliens are not required to be reported as they are not eligible for Medicare and do not have verifiable SSNs.

17. CMS is still working on a model form that could be used by RREs to obtain consent from individuals to report SSNs and confidential information.

January 28, 2009 - Town Hall Conference Call:

The session began with a series of CMS statements, including the following new points:

1. The CMS query function available to Responsible Reporting Entities (RREs) will be triggered by the RRE sending a file with the individuals SSN, name, DOB and Gender. A file will be returned verifying that the individual is Medicare entitled and provide any corrections to the information submitted. Due to confidentially concerns at this time CMS is not going to provide the reason for Medicare entitlement or the date of entitlement. Only one query per month per RRE Identification Number may be submitted. CMS will provide computer based training for free for RREs and/or will provide HIPAA compliant software to assist RREs in reporting.

2. CMS is taking a look at whether it could at least provide the Medicare entitlement information to RREs for the purpose responding to the question of the first exposure of an individual involving such things as ingestion or involving implants as is required in Field No. 12. CMS previously had indicated, in recognition that RREs typically did not have first exposure information, that the reporting requirement would only go back to the date of Medicare entitlement to relieve RREs from guessing about a date that may be speculative. CMS also pointed out that once there is a response indicating that an individual is Medicare entitled, the individual should be able to provide the additional information under applicable regulations.

3. CMS will accept a file submission of all individuals who are over 65 years of age as a streamlined way to relieve the burden of checking on the entitlement of each individual to be reported. Such a submission, however, does not relieve the RRE from assuring that the other individuals who may be Medicare entitled are reported.

4. To make it easier to address situations where there may be multiple TPAs and agents, CMS noted that an RRE may report using multiple RRE Identification Numbers and by doing so enable multiple reporting agents. However, only one quarterly report per RREID may be submitted.

5. The model form to be used to obtain consent from individuals to have their SSNs and private information submitted by the RRE to CMS is still in development.

6. CMS is considering whether an RRE may be permitted to end reporting of ongoing obligations when there is a state statute of limitations after which a claim may not as a matter of law be reopened. Current instructions assume that once there is a report of ongoing obligation the reporting responsibility continues to be open.

7. CMS plans to use the information reported by RREs as a source to deny the payment of medical claims from individuals on the front end until it is determined that there is no ongoing obligation for WC or liability claims to be paid first.

8. CMS continues to review possible codes to be used in addition to WCIO codes, including Department of Labor codes and NCCI codes.

9. Sign up for computer based training is now available through the CMS web site.

10. Registration of RREs will begin May 1, 2009.

Check the CMS web site for additional details at www.cms.hhs.gov/MandatoryInsRep

February 25, 2009 - Town Hall Conference Call:

The Centers for Medicare and Medicaid Services (CMS) conducted a teleconference this afternoon to provide an update on policy and procedure in implementation of the requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (S 2499).

Highlights of the Call Included:

1. The Non-GHP User Guide is now scheduled to be released in the first two weeks of March, and before the next CMS teleconference for Non-GHP.

2. Meetings are being scheduled in April to address specific interest areas, including Workers’ Compensation, Liability, and No-fault issue areas.

3. Computer Based Training is being developed and should be available before May 1st

4. The codes to use in reporting will be provided in the User Guide

5. There will be an interim dollar threshold below which reporting entities will not have to report payments, judgments, settlements, and awards. CMS will review the results before making a permanent threshold. The interim dollar amount will be released with the User Guide

6. The User Guide will also address how far back historically a reporting entity will be required to capture and report information with respect to cases for which there is ongoing obligation to report on and after July 1, 2009.

7. The definition of whether a case should be considered open for purposes of reporting will be addressed in the User Guide

8. The fronting insurance issue will be addressed in the User Guide

9. The model form to use to obtain releases from individuals in order to report information is still in process of development and may or may not be in the User Guide

10. The answer to joint powers questions will be addressed in the User’s Guide

11. The User’s Guide will be 160 pages long and serve as the basis for more detailed discussions leading up to registration and reporting.

12. The CMS query function will take two forms.; 1) a straight query to determine whether an individual is Medicare entitled will be made using an SSN and the response will be only the applicable HICN; 2) a quarterly submission by an RRE, however, that includes individual SSNs, Date of Birth, Gender and name will receive a response that includes not only the HICN, but also any corrections of the other submitted information.

13. Special reporting arrangements and/or definitions related to the Longshore and other USDOL programs is still pending receipt of additional information from the USDOL.

14. The decision on how to handle whether to report settlements of only wage loss with no medical are still pending

15. The handling of mass tort cases is still pending and CMS has scheduled meetings with interested groups in March to discuss the array of related issues.

CMS continues to monitor the progress of the Section 111 reporting requirements and UWC is scheduled to meet with CMS in April to address workers compensation issues that remain outstanding.

Constant monitoring of the CMS web site dedicated to the reporting issue is advisable as we move closer to the July 1, 2009 reporting date. www.cms.hhs.gov/MandatoryInsRep

March 24, 2009 - Town Hall Conference Call:

Highlights of the Call Included:

A number of policy items were not addressed in the User Guide that was released on March 16th or in the Alert sent out on March 20th, including 1) mass torts, 2) bankruptcy and insolvency, 3) further clarification of who RREs are, and 4) the model form to use with individuals to obtain SSNs to be reported.
CMS has been receiving many calls from governmental agencies arguing that they should not be Responsible Reporting Entities but they are likely to fall into the definition if they are making payments or obligated to make payments to individuals under a plan of insurance or pursuant to workers’ compensation, state or federal law.
CMS has finally decided to use ICD 9 codes and may move to ICD 10 as time goes on.
Codes that are used to report “unknown” values will be prohibited
The CMS Alert released on March 20th on the CMS web site extended the permissible testing period to July – September, 2009, production will be October – December, 2009.
RREs must still register and start testing as scheduled and report as assigned no later than the January – March 2010 time frame.
A threshold for workers’ compensation ongoing medicals when all of the following criteria are excluded from reporting for file submission due through December 31, 2010:
- Medicals only
- Lost time of no more than 7 calendar days
- All payments have been made directly to the medical provider
- Total payment does not exceed $600.00
For TPOCs dates of July 1, 2009 through December 31, 2010, TPOC amounts up to $5,000 are exempt from reporting, except that multiple TPOCs on the same RRE record will be added together and when the RRE reports a deductible and amounts above the deductible the $5,000 applies to the total. The threshold level will be evaluated based on workload during implementation and will likely be reduced.

Settlements, including WCMSA amounts are included in determination of the total payment obligation
An updated User Guide will be issued as policy questions are resolved
Use Section 8 of the User Guide for registration instead of earlier instructions
A new registration overview document is being prepared
Computer Based Training and a course for registering should be addressed before registration begins
Policy on Joint Powers Authority is still pending
Section 11.7 of the User Guide provides a broader qualified exception than before. For ORMs assumed prior to July 1, 2009, if the claim was actively closed or removed from current claims records prior to January 1, 2009, the RRE is not required to identify and report that ORM under the requirement for reporting ORM assumed prior to July 1, 2009. If such a claim is later subject to reopening with further ORM, it must be reported with full information, including the original DOI (as defined by CMS) (See p. 52 of User Guide)
Additional teleconferences scheduled in April and May – view dates on CMS web site.
Guidance with respect to the MSP recovery process is available at www.msprc.info. Additional guidance about WCMSAs and general questions may be found at www.cms.hhs.gov/COBGeneralInformation, and www.cms.hhs.gov/WorkersCompAgencyServices. (See p. 82 of the User Guide)

UWC, in concert with IAIABC will host a forum on April 22nd in Baltimore to further discuss issues related to Section 111 reporting and WCMSAs. Please check the IAIABC web site at http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3540 for a description of the forum and registration. The Forum registration fee is waived for UWC members.

Constant monitoring of the CMS web site dedicated to the reporting issue is advisable as we move closer to the July 1, 2009 reporting date. www.cms.hhs.gov/MandatoryInsRep

If you have any questions about these Highlights please contact me.

Doug

Douglas J. Holmes

President

UWC – Strategic Services on Unemployment & Workers’ Compensation

910 17th Street, NW, Suite 315

Washington, DC 20006

202-223-8904

holmesd@uwcstrategy.org

April 9, 2009 - Town Hall Conference Call:

The Centers for Medicare and Medicaid Services (CMS) conducted a teleconference on April 9th to provide an update on policy and procedure in implementation of the requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (S 2499).

Highlights of the Call Included:

Registration for non-GHP reporting entities begins May 1st. A registration portal will be available. CMS advised entities not to try to access the GHP portal even though it is up.
Registration instructions will be available through the CMS web site.
Computer based training should be available next week.
Non-GHP production files will not be accepted until October 1st and will not be required until the scheduled submission date sometime after January 1, 2010.
CMS released a new alert on April 7th on the web site addressing Multiple Total Payment Obligation to the Claimant (TPOC) amounts. The Alert describes how CMS is expanding file records to accommodate multiple TPOC amounts across different areas of insurance (WC, liability, no-fault).
The $600 threshold described in a prior alert requires that all four criteria must be met for a report not to be submitted. CMS may adjust the $600 based on WCRI data.
The fact that an RRE is also a sovereign nation or Indian Tribe does not excuse it from reporting.
The ICD 9 codes are required. If CMS moves to ICD 10 codes or other codes as being permissible for reporting CMS will provide advance notice.
Group trusts are to be treated like reporting pools as RREs (see user guide)
CMS is reviewing unique Texas entities that may be part WC, part liability, and part something else to determine reporting responsibilities
CMS continues to review best ways to address mass torts and product liability
CMS is considering circumstances under which RREs may be permitted to exclude fees and costs from amounts to be reported.
The model form to use in getting claimant approval for use of SSNs is expected by the end of the month.
CMS met with USDOL to discuss reporting under Longshore and other programs. At this point CMS does not expect that insurers and employers will be treated differently for Longshore. They are considering whether payments made directly by USDOL could be reported differently to CMS.

June 9, 2009 - Town Hall Conference Call:

The Centers for Medicare and Medicaid Services (CMS) conducted a teleconference on June 9th to provide an update on policy in implementation of the requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (S 2499).

Highlights of the Call Included:

Indemnification payments must be reported as TPOCs, and depending on the nature of the payment may also be reportable as an ORM. The issue for CMS is that indemnity payments, though largely wage replacement, may include related medical expenses. Because of this, CMS believes it is obligated to require that the payments be reported, even if it is for one day. CMS is interested in finding a way to define wage replacement payments that may not be required to be reported. They are looking at these definitions and interested in hearing suggestions in how to minimize reporting. They are likely to only require that the indemnity payments be reported as part of the quarterly report. CMS is also considering what this means for thresholds below which TPOC reports are not required.
CMS believes that the Texas Non-subscriber program is not workers’ compensation, but is still reviewing its policy to provide guidance as to how to report.

CMS continues to work on many outstanding issues including:

Rules to determine who the RRE is in Bankruptcy situations
Rules to determine who the RRE is during periods of litigation
Defining how to determine the RRE with respect to large deductible plans
Increasing ORM thresholds
Requirements with respect to the stated address on the reports. If there is a US telephone number or address for the entity it should be used instead of a foreign address
CMS is encouraging Holding companies to register as the RREs even if it may have subsidiaries that could also register as RREs. This is to reduce the number of RREs where possible.
CMS will not accept some ICD – 9 listed codes that are not “valid” codes because they do not provide enough information about the nature of the injury, etc. CMS will provide more detail about this

CMS continues to modify requirements as implementation continues.

July 14, 2009 - Town Hall Conference Call:

The Centers for Medicare and Medicaid Services (CMS) conducted a teleconference on Tuesday, July 14th to provide an update on policy in implementation of the requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (S 2499).

Highlights of the Call Included:

1. CMS expects an updated User Guide for Non-GHPs to be released by the end of July

2. It is critical that each RRE when registering for reporting identifies an unauthorized representative and then after a PIN letter is generated that an account manager is identified. If an erroneous authorized representative is initially identified, RREs should contact their EDI representatives.

3. A series of corrections to the COBC secure web site will be made over the weekend to address submission of files (text only – no zip files), the RRE sort function, and the profile report.

4. A number of alerts and/or user guide updates are in queue to address

Hospital write off for risk management

Product Liability and Mass Tort – CMS still asking for participants in a group to develop policy

Workers' Comp Periodic Payments – if WC law clearly provides that payments include no past, current or future medical may be excluded from ORM reports

Self Insurance: Who is and who is not an RRE – the question of who is an RRE will be published for comment

Corporate structure – who is the RRE in multiple entity situations. Parent may report for subsidiaries, but “sibling” entities may not report for each other

Deductibles – if it is clear that the insured is making payment less than deductible amount insured is RRE;

Fronting policies – insured is the RRE

Self Insurance Pools – the pool is not the RRE if payments made only for administrative support

Bankruptcy/insolvency – state guaranty fund may become RRE for payment, special treatment in liquidation.

NOTE: THE NOTES ABOVE ARE NOT THE ACTUAL PROVISIONS AND ONLY BRIEF NOTES FROM THE CONFERENCE CALL. REFER TO THE CMS WEB SITE AND THE ALERTS AND USER GUIDE AS THEY ARE PUBLISHED AT LINK BELOW.

http://www.cms.hhs.gov/MandatoryInsRep/

WSIA's Conference Call Notes

October 29, 2008 - Town Hall Conference Call:

There were so many callers that they never got to me for any WA related questions. Here's what I did get out of it:

1. There is an expectation that we report anyone who is Medicare eligible. They are not expecting us to report every claim.

2. They are working to find out a way for us to determine who is eligible and how to get us query capability. Query capability would require that we already have the Social Security number of the person. They hope to have something out on that in the next week or so.

3. They want reporting to occur in the quarter that follows the "settlement, judgment, or award" but were still not clear on how that related to our state (Washington) and we ran out of time before they got to my questions.

4. Date of injury is not the trigger to reporting. It is the settlement, judgment, award, or payment date.

5. Reporting applies only to Medicare, not Medicaid.

6. They have not established a minimum value yet for reporting threshold.

7. There were questions about disputed ICD-9 codes, but no clear answer on that.

8. Corrections to errors may only be made quarterly during the normal reporting schedule. No mid-report reporting.

Issues I had planned to bring up, but didn't get to:

1. Pension claims with treatment orders - specify what is paid.

2. Board settlements.
3. Claims closed with or without PPD - Treatment ends at closure, but is essentially open ended due to reopening laws and Director's discretion.

January 22 , 2009 - Town Hall Conference Call:

Here are a few highlights/reminders from the call today and no, I did not get my question about "ongoing responsibility for medical care" asked.

Responsible parties must register between 5/1/09 and 6/30/09
Confirmed registrants may begin data testing after 7/1/09 with a limitation on testing files of 100 records.
Go live for reporting is 10/1/09.
The user guide is still in development and is expected to be issued in February.
In a few days, there will be an alert issued to assess interest in various groups having either in person or conference training. This seems to be a possible opportunity for our membership.
The data codes for WC are not finished yet.
They are looking at the issue of claims already closed and how far back they want records. They want only cases where ongoing responsibility for medical care was assumed prior to 7/1/09 and then all of those after.
They will have some computer based training, but that is not done yet. They recommend doing it ahead of time.
For reporting, they ONLY want people who are already entitled to medicare, not those who may be in some number of months. (Good news for us).
We are not allowed to report all claims. Only those who are eligible beneficiaries.
Query function - (This is very important for us) We will be allowed to send a query file monthly to CMS to find out who is eligible. Data for that will likely include SS#, Name, Date of Birth and gender. If there is a match, they will send back the data with the Medicare #. That will filter out those claims that are not reportable. You'd then submit back to them only the reportable claims. CMS will provide the software or layout to comply with HIPAA.

April 9, 2009 - Town Hall Conference Call:

Dave Kaplan Notes from CMS Town Hall – April 9, 2009

REGARDING REGISTRATION: Registration available beginning May 1, 2009 for RRE’s.

www.section111.cms.hhs.gov, login warning, click “I accept”, then read the “How To” information. There will be a user guide for those registering, but you have to establish a log-in name and user-id first.

REGARDING MULTIPLE OPEN CLAIMS: Separate claims must be reported separately.

REGARDING EMAIL COMMUNICATIONS: All email communications will go to the account manager only.

REGARDING SOCIAL SECURITY NUMBER MATCHING: As long as the SSN was accurate, it should match correctly whatever name the claimant has used over the years.

REGARDING LIMITATION OF REPORTING TO CLAIMS AFTER 1/1/1989: CMS believes you should be able to find this information, and computerize it if you’re currently paying for medical.

We will continue to add more notes from the conference calls, as they are made available. Check back here on a periodic basis.

as of 19 June 2009