Beginning October 11, 2024, the Centers for Medicare & Medicaid Services (CMS) has announced that it will audit 1000 records to determine if employers are complying with Medicare section 111 reporting. CMS stated that its audit will focus solely on timeliness of employers reporting section 111 claims to CMS.
CMS considers Texas nonsubscriber programs Non Group Health Plans (NGHP) that are subject to liability rules for reporting claims involving Medicare beneficiaries. For claims involving injured workers that are Medicare beneficiaries, Responsible Reporting Entities (RREs) for Texas nonsubscriber programs must report such claims within one year of:
- The date of a settlement judgment, award or other payment (TPOC); or
- The date when the Texas nonsubscriber begins ongoing responsibility for medical payments (ORM) – whether through its ERISA benefit plan or a structured settlement.
Penalties for NGHP noncompliance are:
- (1) $250/day for records reporting between 1-2 years after the reporting due date,
- (2) $500/day for records reported 2-3 years after the reporting due date, and
- (3) $1,000/day for records reported 3 years or more after the reporting due date.
CMS provides exceptions when NGHP failure to report is due to the RRE’s inability to obtain a claimant’s identifying information and the RRE has made good faith efforts.