CMS Publishes Technical Alert on Mandatory Reporting and Recovery Agents

Rafael Gonzalez, Esq.

Vice President, Strategic Solutions, Helios

 

On March 1, 2016, the Centers for Medicare and Medicaid Services, Office of Financial Management, Financial services Group (CMS), published a Technical Alert pertaining to Medicare Secondary Payer (MSP) Mandatory Reporting Provisions Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (See 42 U.S.C. 1395y(b)(7)&(b)(8)) (MIR). This latest Technical Alert is a reminder of the November 10, 2014 Technical Alert published by CMS announcing that effective July 13, 2015, Responsible Reporting Entities (RRE) were able to submit their recovery agent information in designated fields on the Tax Identification Number (TIN) Reference File and Direct Data Entry (DDE) claim submissions. The 3/1/16 Technical Alert reiterates the 11/10/14 Technical Alert, reminding RREs that the submission of recovery agent information should be done in the TIN Reference File designated fields. The 3/1/16 Technical Alert further reminds MIR stakeholders that the workaround for submission of a “Third Party Administrator (TPA) Address” should not be used. Instead, should RREs wish to have a recovery agent indicated to handle any aspect of their recovery work, RREs are encouraged to use the new reporting methodology as both the RRE and recovery agent will be copied on recovery correspondence.

 

The 3/1/16 Technical Alert reminds RREs that effective 7/13/15, CMS implemented a solution for recovery agent information reporting that rendered the previous “Third Party Administration (TPA) workaround” (i.e. submitted recovery agent information in TIN Reference File fields intended for the RRE) obsolete. RREs that previously used this workaround should have resubmitted all TIN Reference File records with up-to-date recovery agent information in the specified recovery agent fields (fields 16-22) and RRE information in the RRE/TIN fields (fields 2-15). The 3/1/16 Technical Alert again reminds RREs they should resubmit corrected TIN Reference File records, if they have not already done so, to avoid inappropriate recovery actions.

 

Medicare uses information provided on the TIN Reference File records to identify the correct debtor for recovery efforts of conditional payments. Based on this information, Medicare issues recovery correspondence to the RRE and its recovery agent, if one has been designated by the RRE. Therefore, it is the RRE’s responsibility to ensure the TIN Reference File records are accurate and up-to-date. Unless the RRE has put together a comprehensive plan to handle such conditional payment recovery letters, failure to resubmit TIN Reference File records with correct information in the appropriate fields may result in collection actions against the RRE, including referral to the Department of Treasury.

 

For more information on submitting recovery agent information via the TIN Reference File, see the following links:

 

 

Helios Settlement Solutions’ MedicareConnect℠ is the most advanced, tested, and accurate Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 Mandatory Insurer Reporting platform in the country. With a proven track record as a reliable and trusted recovery agent for some of the largest self-insureds and insurers in the US, we welcome your questions, issues, or concerns about your current MIR process, vendor, or recovery agent. Please contact us at 888.672.7674, or at contactus@helioscomp.com.

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About Rafael Gonzalez

As vice president of strategic solutions, Rafael Gonzalez serves as a thought leader on all aspects of Medicare and Medicaid compliance issues, including mandatory insurer reporting, conditional payments resolution, Medicare set aside allocations, CMS approval, and professional administration of Medicare set asides and special needs trusts. Prior to joining Helios, over the last 30 years, Rafael served as director of Medicare & Medicaid compliance and post settlement administration for Gould & Lamb in Bradenton, Florida. Before that, he served as chief executive officer for the Center for Lien Resolution, the Center for Medicare Set Aside Administration and the Center for Special Trusts Administration in Clearwater, Florida. Prior to that, he served as corporate counsel for FCCI Insurance, a workers’ compensation/property casualty insurance company in Sarasota, Florida. And before that, he practiced social security disability, workers’ compensation, longshore and personal injury law in Tampa, Florida. Rafael Gonzalez received his Bachelor of Science degree from the University of Florida and his Jurisprudence Doctorate degree from the Florida State University.

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