Who is the Responsible Reporting Entity “RRE”?
Quite simply, the party funding the payment directly to the claimant is the Responsible Reporting Entity.
In a continuing effort to help keep you up-to-date on happenings in Medicare contributor Gould & Lamb, offer a summary of important and timely information of who the Responsible Reporting Entity (RRE) is continues to draw many questions throughout the industry. There are various industry opinions and policies contrary to the Centers for Medicare & Medicaid Services’ (CMS) published statements on this topic. CMS’ most current published guidelines on who is the RRE are summarized below. While CMS has indicated they are reviewing this subject, their current policy is very plain. The following is from CMS’ Mandatory Insurer Reporting (MIR) Announcement released in August 2008 and can be found in the CMS Supporting Statement document on Pp 13-14.
Liability Self-Insurance:
42 U.S.C. 1395y(b)(2)(A) provides that an entity that engages in a business, trade or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part. Self-insurance or deemed self-insurance can be demonstrated by a settlement, judgment, award, or other payment to satisfy an alleged claim (including any deductible or co-pay on a liability insurance, no-fault insurance, or workers’ compensation law or plan) for a business, trade or profession. See also 42 C.F.R. 411.50.
SPECIAL CONSIDERATIONS WHERE LIABILITY SELF-INSURANCE WHICH IS A DEDUCTIBLE OR CO-PAYMENT FOR LIABILITY INSURANCE, NO-FAULT INSURANCE, OR WORKERS’ COMPENSATION IS PAID TO THE INSURER OR WORKERS’ COMPENSATION ENTITY FOR DISTRIBUTION (RATHER THAN DIRECTLY TO THE CLAIMANT):
As indicated in the definition of “liability self-insurance,” such deductibles and co-payments constitute liability self-insurance, and require reporting by the self-insured entities. However, in order to avoid two entities reporting with possible confusion where the deductibles and/or co-payments are physically being paid by the insurer, CMS is considering requiring such deductibles and co-payments to be reported as part of the insurer report. CMS specifically seeks comments on this approach. If this approach is not adopted, both entities will have to report in this situation. Regardless of the final decision on this approach, CMS may need to add a few additional data elements (in the form of a question or otherwise) so that it will clearly be able to identify such situations.
It is clear that where the deductible is funded by the insured, CMS is considering this a type of self-insurance and requires the insured to register and report. It should be noted where CMS indicates that if the deductible is paid to the insurer, not the claimant, CMS was considering a position that the insurer be the RRE to avoid the requirement of dual reporting. CMS clarified this position on 3/16/09 with the release of the User Guide. The following excerpt is from the User Guide:
Where an entity is self-insured for a deductible but the payment of that deductible is done through the insurer, then the insurer is responsible for including the deductible amount in the amount it reports as a settlement, judgment, award or other payment.
In summary, if the insured funds payments to the claimant in the form of a deductible they are the RRE. If the insurer funds payment to the claimant within the deductible layer and seeks reimbursement from the insured, the insurer is the RRE. This “funding method to the claimant” philosophy continues to excess insurance and reinsurance as well. See below from the CMS User Guide published on 3/16/09:
For re-insurance, stop loss insurance, excess insurance, umbrella insurance, guaranty funds, patient compensation funds, etc. which have responsibility beyond a certain limit, the key in determining whether or not reporting for 42 U.S.C. 1395y(b)(8) is required for these situations is whether or not the payment (from the excess/reinsurer) is to the injured claimant/representative of the injured claimant vs. payment being made to self-insured entity to reimburse the self-insured entity (for payments made to the claimant). Where payment (from the excess/reinsurer) is being made to reimburse the self-insured entity, the self-insured entity is the RRE for purposes of the payment made to the injured individual and no reporting is required by the insurer reimbursing the self-insured entity.
Again, once the re-insurance or excess insurance level is pierced, it is a function of who is funding the payment to the claimant that determines the RRE. If the insurer begins funding payments, they become the RRE. If the insured continues to fund the payments and seeks reimbursement from the insurer, they remain the RRE.
TO REPEAT:
The party funding the payment directly to the claimant is the Responsible Reporting Entity.
CMS may change their rules and this is a fluid environment, but due to the enormous number of questions being posed on this topic and the confusion it has generated, we felt it was prudent to revisit CMS’ current policy with all clients. If you have been receiving conflicting information from any party, please feel free to share this communication with them and obtain their source and reference for their current position regarding who the RRE should be. Please feel free to contact us with any comment or questions.
Author: Gould & Lamb welcomes questions feedback and comments. Contact them at: 866-MSA-FILE (672-3453).
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Employers have a vested interest in assisting workers injured at work to promote their healing and return to work. One of these ways is by making sure they receive the workers' compensation due them in a timely manner, with a minimum of hassle. HR 2641 addresses this in terms of workers' compensation Medicare set asides and payments. A coalition of attorneys representing injured workers, employers, insurance carriers, defense attorneys, and other interested parties are applauding the introduction by House Representative John Tanner (D-TN) of HR 2641. HR 2641 is designed to resolve the serious delays and confusion in the review of workers' compensation Medicare set aside by the federal agency responsible for administration of Medicare, the Centers for Medicare and Medicaid Services (CMS). "The Medicare Secondary Payer and Workers' Compensation Settlement Act of 2009 will provide clear and consistent standards for CMS' administrative process," according to Douglas Holmes, president of Strategic Services on Unemployment and Workers' Compensation (UWC) and coordinator of the Coalition for Medicare Secondary Payer (MSP) Reform. According to Holmes, "CMS takes too long to review proposed set-asides, fails to provide consistent standards for determining amounts to be set aside, and provides no avenue for appeal of their determinations. The process results in injured workers not receiving funds, additional costs for states and workers' compensation payers, and additional liability for employers, insurance carriers, (italics added) and attorneys in contravention of the state workers' compensation exclusive remedy principle. A legislative solution to this problem is needed." Ed Romano, president of the Workers' Injury Law and Advocacy Group (WILG), the national association of attorneys representing injured workers in workers' compensation cases, noted that too often, injured workers bear the brunt of the delays caused by the current system and reforms are needed now. "This bill is about process improvement and fair treatment of all parties," Romano remarked. "We applaud Representative Tanner for taking on this issue. "In case after case we hear of delays in approval, uncertainty of the amount to be reimbursed by injured workers, and changes in amounts to be set-aside after settlements have been approved." Holmes believes the current MSP procedure does not allow for any recourse, noting, "There is no avenue to compel a timely decision or appeal a bad one. The legislation introduced by (workersxzcompxzkit) Representative Tanner corrects this situation and many other costly problems and delays, for the benefit of all parties involved – most importantly the injured workers." To view the entire bill, visit: http://www.govtrack.us/congress/billtext.xpd?bill=h111-2641. Click on these links to try it for yourself. WC Calculator: www.ReduceYourWorkersComp.com/calculator.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101: www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
In a continuing effort to help keep you up-to-date on happenings in Medicare we offer the following summary of important and timely information about MSA compliance.
Today’s Centers for Medicare & Medicaid Services (CMS) Town Hall Meeting focus was Non-Group Health Plans (NGHP) Registration with additional clarifications regarding registration, testing and software availabilities. CMS announced a further extension of the Section 111 Reporting dates.
CMS will be releasing the following information as alerts:
1. Responsible Reporting Entity (RRE) Registration has been extendedfrom May 1st, 2009 through September, 30th 2009.
2. The Testing period has been extended from January 1st, 2010 through March 31th, 2010.
3. Total Payment Obligationto the Claimants (TPOCs) occuring prior to January 1st, 2010 are not reportable. This is not true of ORM’s, which will need to be reported as of July 1st, 2009.
4. Reporting will begin April 1st, 2010.
Contributed by Gould and Lamb, the nation’s leader in Medicare Secondary Payer (MSP) and Mandatory Insurer Reporting (SCHIP) compliance.
Click on these links to try it for yourself.
WC Calculator www.ReduceYourWorkersComp.com/calculator.php
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WC 101 www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Based on the many requests coming into the blog, inquiring minds want to know! So, here’s a list of some of the most common abbreviation used by the Center of Medicare and Medicaid Services (CMS) to describe their many services and programs.
AD: Account Designee. Assigned by the Account Manager
AM: Account Manager. Assigned by the Authorized Representative
AR: Account Representative. Can contractually bind the insurer
COBC: Coordination of Benefits Center. Responsible for receiving MQF and MIR files
COBSW: Coordination of Benefits Secure Web-Site. For RRE registration processing
CP: Conditional Payment
CPR: Conditional Payment Research
CMS: Centers for Medicare & Medicaid Services
CSA: Claim Settlement Allocation
EDI: Electronic Data Interface
LC: Lead Contractor, see MSPRC
MIR: Mandatory Insurer Reporting
MMSEA: Medicare & Medicaid State Children’s Health Insurance Program Extension Act
MQF: Medicare Query Function. Used to determine Medicare eligibility & reporting requirements
MSA: Medicare Set Aside. Allocation
MSP: Medicare Secondary Payer
MSPRC: Medicare Secondary Payer Recovery Contractor. Responsible for recovery of CP
NAIC: National Association of Insurance Commissioners
NGHP: Non-Group Health Plans. Workers’ compensation, liability, auto No-fault, etc.
PIN: Personal Identification Number. For COBSW
RRE: Responsible Reporting Entity
RRE ID: Responsible Reporting Entity Identification
SCHIP: State Children’s Health Insurance Program
S/J/A: Settlement/Judgment/Award
TIN: Tax Identification Number
TPA: Third Party Administrator
TPOC: Total Payment Obligation of Claimant
Thank you to Gould & Lamb, LLC, for providing this list of abbreviations. They can be contacted at www.GouldandLamb.com.
Click on these links to try it for yourself.
WC Calculator www.ReduceYourWorkersComp.com/calculator.php
TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
In addition to the recent publication of the Non-Group Health Plans (NGHP) User Guide on 3/16/09, Center for Medicare & Medicaid Services (CMS) recently released an Alert intended to answer a few open issues remaining from the User Guide. The Alert was published on March 23, 2009. Contained within the Alert are a few key updates: Extended Testing Periods CMS has extended the testing period an additional three months. Testing will now occur between 7/1/09 and 12/31/09, shifting the requirement for live-data reporting to Q1 2010. This is substantial from a preparation standpoint, but should not give anyone the mistaken hope that it is time to slow down. Registration is a lengthy multi-step process still scheduled between 5/1/09 and 6/30/09 (just 36 days away). Registration is expected to include tens of thousands of Responsible Reporting Entities (RREs). After registration, each RREs Reporting Agent must conduct a series of data tests with the Coordination of Benefits Center (COBC) before the first Medicare Query Function (MQF) file can be submitted. Imagine how long this testing might take CMS to complete with +50,000 RREs registering at the same time. After successful completion of the testing, an MQF file must be loaded to CMS to determine Medicare beneficiary status on the RRE's claims. It takes CMS 14 days to respond to the MQF file. The MQF response file from CMS will tell us which claims need to be reported in the first Mandatory Insurer Reporting (MIR) input file as early as January 2010. All of these cases involving Medicare (workersxzcompxzkit) beneficiaries must be updated to include CMS' new required data. This is a large endeavor for an Insurer/TPA/self-insurer, requiring a great deal of time pre-live reporting. As an example, if you have 500,000 open claims and 8% of them involve a Medicare beneficiary, then 40,000 claims need to be updated to meet CMS reporting requirements. If your system is robust and captures 100 of the 180 CMS fields, there are still up to 80 fields per claim to enter, or roughly 3.2 million individual items for data entry. Bottom-line: The extended testing period just gives us more time to get our files in order for the 1st live report in Q1 2010. Don't relax yet.Interim Reporting Thresholds CMS has also offered some much wanted low dollar thresholds for settlements, judgments, and awards Settlement/Judgment/Award (S/J/A) in workers' compensation (WC) and liability, meaning these cases do not need to be reported at the time of S/J/A. What is interesting about the thresholds is that they reduce over time. Here is the summary of these thresholds and their effective dates: TPOC* Date between 7/1/09 and 12/31/10 and TPOC Amount less than or equal to $5000.00 – Not Reportable
- TPOC Date between 1/1/11 and 12/31/11 and TPOC Amount less than or equal to $2000.00 – Not Reportable
- TPOC Date between 1/1/12 and 12/31/12 and TPOC Amount less than or equal to $600.00 – Not Reportable *TPOC: Total Payment Obligation of Claimant.
After 1/1/13, all TPOC Amounts will be reportable. CMS reiterates that these are not "safe harbors" and that their MSP rights apply regardless of whether or not the S/J/A is reportable through MIR. They reserve the right to change these thresholds in the future. Multiple TPOC Amounts must be summed to determine if the threshold was breached, no cheating by breaking the settlements into 47 individual settlements allowed. Another threshold they discussed is only applicable to Workers' Compensation cases with ORM (Ongoing Responsibility for Medicals) through 12/31/10. It appears to have been developed to focus on medical only claims with little to no loss time and limited medical payments. The rules for this exception are clearly articulated in the attached document. There is no threshold for liability or no-fault cases with ORM. Bottom-line: These thresholds take away reporting responsibility on a lot of nuisance value settlements and claims in the short term, but eventually everything will be reported. Conclusion There were also a few technical notes and updates that are ultimately not relevant unless you are a Reporting Agent in the Alert. Both the testing extension and interim reporting thresholds were much desired requests from the industry. CMS has delivered on both in the short term, but ultimately we will be reporting all the data CMS needs to enforce its Secondary Payer Rights in workers compensation, liability and no-fault. Many thanks to Gould & Lamb, LLC for providing this article. Click on these links to try our calculators and WC 101. WC Calculator www.ReduceYourWorkersComp.com/calculator.php TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC 101 www.ReduceYourWorkersComp.com/workers_comp.php Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs. ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
As outlined in the Medicare Supporting Document (8/1/08) for the new SCHIP Section 111 reporting requirements, the start date for Group Health Plans (GHP) was scheduled to be 1/1/09 and Workers Compensation, Liability and No-Fault Auto (non-GHP) was scheduled to be 7/1/09. Medicare issued a revised Implementation Timeline that gives the industry a bit more breathing room. Effective with this new memo, GHPs that currently participate in a VDSA must begin reporting on 1/1/09. However, those currently not participating in a VDSA will have until 4/1/09 to begin registration with 1st reporting required 7/1/09.Non-GHP will be required to register by 5/1/09 with detailed reporting taking place between 10/1/09 to 1/1/10.
Click here for a downloadable timeline:
https://www.cms.hhs.gov/MandatoryInsRep/Downloads/MMSEATIMELINE.pdf
As always, Gould & Lamb appreciates your business and welcomes your feedback and comments. Should you have any questions, please contact us directly at: 866-MSA-FILE (672-3453).
Note: Make sure to obtain independent verification before using this information. All situations are different and may not apply to all companies.
For MSAs, in addition to the compliance requirements that come with the MSP, there are new compliance requirements coming down the pike on 7/1/2009. On December 29, 2007, President Bush signed the SCHIP Extension Act of 2007 (SCHIP), Section 111. The reporting requirement will become effective in 7/1/2009 and will carry a monetary civil penalty for failure to report at the rate of $1,000 per day per claim per day. The Congressional Budget Office predicts that the federal government will recover $1.1 billion in fines in the first 5 years. If you would like more information about this, contact www.GouldandLamb.com.
Managing "Medicare risk" is a growing concern for carriers, TPAs, and self insured self administered employer groups. Adequate consideration must be given to Medicare when closing or limiting future medical as part of a settlement. When managing your Medicare risk for "qualified claimants," parties must secure Medicare Set-Asides (MSAs). In order to manage the Medicare risks, respective parties should comply with the requirements derived by the Medicare Secondary Payer Statute (MSP) & the State Child Health Insurance Program (SCHIP), Section 111. The United States Code, Title 42, Chapter 7, Subchapter XVIII, Section 1395Y comprises the Medicare Secondary Payer Statute (MSP). The law requires that "adequate consideration" of Medicare's interests be made in all Workers' Compensation settlements that seek to limit or close future medicals. Medicare's administrative guidelines require that settlements with "qualified claimants" be reviewed and approved by Medicare in order to create a compliant settlement. A Medicare Set-Aside is a projection of the future Medicare covered medical expenses associated with the workers' compensation claim. The MSA allocation can be self administered or professionally administered by a custodial fund administrator. Annual reporting is required to CMS (Center For Medicare and Medicaid Services). Employers should work closely with a national/regional structured settlement firm, and fund the MSAs with annuities – as this will position them to control their loss dollar spent on MSA allocations. Using annuities to settle claims means saving on each MSA. Partnering with a leading firm allows you to manage your Medicare Risk as a "program." If you are working with a particular firm, include that in your account instructions.
If you need more information about Medicare Set-Asides, you can contact www.gouldandlamb.com. Thanks Gould and Lamb for providing this important information.
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