The reporting required by CMS to fulfill Mandatory Insurer Reporting (MIR) requirements went live on January 1, 2011. The processes to achieve full compliance are complex and require extensive technology, data scrubbing and timely submission for entities that must report claims. Many reporting entities have encountered difficulties, including significant issues with data validation—resulting in either not reporting eligible claims or unnecessarily reporting ineligible claims to CMS. These data issues can increase risk for payers, as data reported with errors can result in temporary suspension of reporting with CMS, increasing the risk of non-compliance penalties. Following is a sample of some of the challenges RREs face in meeting compliance and the potential results of these issues.
PMSI has been informed that the MSPRC has resumed issuing Demand letters as of June 27th. Copies of the revised Demand letters are available on the MSPRC website. PMSI has noted that the most significant changes to the Demand letter are as follows: The addition of language stating that Medicare will not initiate any recovery … Read moreMSPRC Resumes Issuance of Demand Letters