Comments (0)

By Settlement Solutions, May 21, 2013 3:35 pm

We previously blogged about a case wherein Medicare was unable to recover conditional payments due to the fact that the claimant sought unauthorized treatment under Texas workers’ compensation law. Please click here to read our prior blog.

On appeal, the Firth Circuit has affirmed this decision; please see Caldera v. The Insurance Company of the State of Pennsylvania, 2013 U.S. App. LEXIS 9706 (May 14, 2013).

It is likely that this decision will be appealed to the U.S. Supreme Court, and until such time the Supreme Court decides whether or not to hear the case, this decision remains controversial. Some view this decision as a burden shift to the taxpayer, due to the fact that Medicare was unable to recover payments where a claimant did not exhaust his state workers’ compensation administrative remedies.

Others view this case as a wise decision and beneficial for workers’ compensation carriers due to the fact that the treatment sought by the claimant in this case was unauthorized under Texas workers’ compensation; therefore the workers’ compensation carrier did not become primary and responsible for repayment to Medicare.

PMSI will continue to follow this case and will keep its subscribers updated on any developments with regard to a possible appeal to the U.S. Supreme Court.

Comments (0)

By Settlement Solutions, May 16, 2013 11:11 am

A liability case out of a District Court in Louisiana, Benoit v. Neustrom, 2013 U.S. Dist. Lexis 55971 (April 17, 2013), issued an order wherein an LMSALiability Medicare Set-Aside was apportioned and reduced. A Motion for Declaratory Judgment was filed by Michael Benoit (“Plaintiff”), in which he sought a judgment to declare the interests of Medicare satisfied with a reduced LMSALiability Medicare Set-Aside proportionate to the Plaintiff’s recovery.

The facts preceding the settlement involved the Plaintiff filing suit against Michael Nuestrom, individually and as Sheriff of Lafayette Parish, and Rob Reardon, individually and as Warden of the Lafayette Parish Correctional Center (collectively, “Defendants”). The Plaintiff alleged that the Defendants and their employees failed to properly evaluate his condition upon his transfer to Lafayette Parish Correctional Center. Specifically, he claimed he was not given a pre-medical evaluation when he was suffering in his cell from the effects of alcohol detoxification. The Plaintiff was later found face-down and unresponsive in his cell; he was diagnosed at the hospital with hypoxic brain injury, secondary to seizure, followed by cardiac arrest, secondary to alcohol withdrawal and hypoxic encephalopathy. He was admitted to the hospital and received treatment including physical, occupational and speech therapies. Upon discharge from the hospital, Benoit was placed in a nursing home and then moved to outpatient care.

In October of 2012, the parties reached a settlement agreement, conditioned upon the Plaintiff’s release of all claims against all Defendants and the Plaintiff’s assumption of sole responsibility for protecting and satisfying the interests of Medicare and Medicaid. At that point in time, an LMSALiability Medicare Set-Aside projection was prepared by an independent MSAMedicare Set-Aside vendor which estimated that the cost of future medical expenses would range from $277,758.62 to $333,267.02. Additionally, the parties established an amount to reimburse Medicare for past conditional payments and establish a special needs trust in exchange for a lien waiver by Medicaid.

The remaining issue for the court’s consideration was the Plaintiff’s future medical care as a result of the alleged accident and the extent to which the LMSALiability Medicare Set-Aside can or should be reduced to account for the financial hardship to the Plaintiff. The court noted and received the following into evidence: 1) the settlement amount was $100,000; however, the amount due to the Plaintiff would be reduced to $55,707.98, after payment of fees, expenses and Medicare conditional payments; 2) the LMSALiability Medicare Set-Aside prepared by an MSAMedicare Set-Aside vendor which demonstrates that the future medical cost estimates are considerably larger than the net settlement figure; and 3) a Social Security financial statement offered to demonstrate financial hardship on the Plaintiff.

Before diving into the court’s decision and its logic, it should be noted that CMSCenters for Medicare and Medicaid Services was noticed on the hearing for the Motion for Declaratory Judgment. The United States Attorney / CMSCenters for Medicare and Medicaid Services declined to participate in the hearing; however, they did issue a letter to all parties of the litigation declaring an amount due of $2,777.88 to CMSCenters for Medicare and Medicaid Services for past conditional payments. Therefore, CMSCenters for Medicare and Medicaid Services did not provide its input on a major issue that the parties were seeking to resolve—the future medical aspect of Medicare Secondary Payer (MSPMedicare Secondary Payer Act) compliance in the settlement. The settlement parties had already addressed the conditional payment aspect of the case.

Since the court did not have CMSCenters for Medicare and Medicaid Services to opine on the future medical aspect of this case, when considering the Plaintiff’s Motion for Declaratory Judgment, the court looked to two main items for guidance on possible apportionment to the LMSALiability Medicare Set-Aside: a handout from the MSPMedicare Secondary Payer Act Regional Coordinator for CMSCenters for Medicare and Medicaid Services in Region VI (aka “Stalcup memo”) and the well known MSPMedicare Secondary Payer Act case, Bradley v. Sebelius, 621 F.3d 1330 (11^th Cir. 2010).

In the Bradley case, the probate court reduced Medicare’s lien based on the proportion of Medicare’s contribution to the total settlement’s potential worth, had adequate funds been available. The DHHSDepartment of Health and Human Services disagreed with the probate court’s decision citing that the MSPMedicare Secondary Payer Act Manual provided them with a full right of recovery. The district court agreed with the probate court and upheld its decision, finding that the MSPMedicare Secondary Payer Act field manual did not hold the weight of the law and that there is a strong public interest in encouraging settlement in the interests of judicial economy. Additionally, the court noted that within the Stalcup memo the only situation in which Medicare recognizes allocation of liability payments to non-medical losses is when payment is based on a court of competent jurisdiction’s order after their review of the merits of the case.

Between the Stalcup memo and the Bradley case, as well as recognizing the fact that Medicare does not have a formal policy in place for LMSAsLiability Medicare Set-asides, the court resorted to making its own finding of fact as to the appropriate amount of the LMSALiability Medicare Set-Aside. A court-ordered equitable allocation could be considered reasonable based upon guidance in the Bradley case and the Stalcup memo.

The Plaintiff argued that 10% of the gross settlement proceeds would be an equitable amount since the recovery obtained was 10% of the possible recovery if he had prevailed on all the liability issues. The court disagreed with that methodology, but still found that an equitable allocation was in order for the Plaintiff’s family due to his financial hardship. Noting that the mid-point of MSAMedicare Set-Aside projections was $305,512.50, and that the settlement is 18.2% of that figure, the court found that the LMSALiability Medicare Set-Aside amount should be $10,138.00. (The percentage of 18.2% was determined by the court by dividing the net proceeds to the Plaintiff by the mid-point amount of the LMSALiability Medicare Set-Aside. More specifically, the $10,138.00 amount was determined by multiplying the 18.2% to the net proceeds to the Plaintiff of $55,707.98.)

This decision is interesting as it is the first of its kind seen by the industry. Since CMSCenters for Medicare and Medicaid Services has not yet provided any formal guidance around LMSAsLiability Medicare Set-asides, this methodology could be used by liability settlement parties in order to achieve appropriate consideration of Medicare’s interests while still allowing settlement.

Parties settling with Medicare beneficiaries should consider their risk tolerance and the circumstances of each case before deciding the best methodology to achieve consideration of Medicare’s interests with regard to any allocation of future medical treatment. While CMSCenters for Medicare and Medicaid Services has not formally approved the LMSALiability Medicare Set-Aside calculation used in this case, the fact that the court issued an order on the appropriate/equitable amount of the LMSALiability Medicare Set-Aside after reviewing the merits of the case, it would seemingly prevent CMSCenters for Medicare and Medicaid Services from challenging the court’s order pursuant to their own guidelines.

Comments (0)

By Settlement Solutions, April 24, 2013 4:25 pm

Medicare Advantage Plans (MAPsMedicare Advantage Plans), also known as Medicare Part “C”, are private insurance plans which provide Medicare benefits to beneficiaries. A beneficiary may opt to receive their Part A and B Medicare benefits through a MAPMedicare Advantage Plan rather than through traditional Medicare. Often times, MAPsMedicare Advantage Plans offer more flexibility in benefit options and pricing than traditional Medicare. Additionally, all Part D prescription benefits are provided by MAPsMedicare Advantage Plans as Medicare does not provide Part D prescription benefits directly. It has been estimated that approximately 25% of Medicare beneficiaries are enrolled in some type of MAPMedicare Advantage Plan, and that number is expected to increase over time.

If you handle workers’ compensation or liability claims, you may be wondering what MAPsMedicare Advantage Plans have to do with recovery rights under the MSPMedicare Secondary Payer Act or the extent of those rights.   

It has been questioned for some time whether MAPsMedicare Advantage Plans simply have a contractual right to recover conditional payments made when a primary payer exists, or if they have similar rights to Medicare, in that they could pursue an action for double damages for a primary payer’s failure to reimburse Medicare conditional payments. Below is a brief timeline which displays where we are today and references the recent impactful cases, Parra v. PacifiCare of Arizona, and In Re Avandia Marketing as well as CMSCenters for Medicare and Medicaid Services’ input on this issue through a memorandum.   

December 5, 2011- CMSCenters for Medicare and Medicaid Services issues a memorandum in support of MAPsMedicare Advantage Plans having the right to collect for payment of services where Medicare is not the primary payer. CMSCenters for Medicare and Medicaid Services even goes as far as to state that MAPsMedicare Advantage Plans can exercise the same rights of recovery that the Secretary exercises under the existing MSPMedicare Secondary Payer Act regulations. This memorandum was likely prompted by the initial decisions in Parra and In Re Avandia which found that MAPsMedicare Advantage Plans simply had a contractual right to recovery, and did not have the same rights as Medicare to recover conditional payments. For a copy of this memorandum, please click here. 

July 12, 2012- The District Court decision from In Re Avandia is overturned in the Third Circuit Court of Appeals. The Third Circuit finds that MAPsMedicare Advantage Plans have the same rights to recovery as Medicare, and additionally MAPsMedicare Advantage Plans have a right to pursue a private cause of action for double damages under the MSPMedicare Secondary Payer Act for conditional payments that are not reimbursed. To view our legal bulletin on this case, please click here.

April 15, 2013- The U.S. Supreme Court denies certiorari/review of the In Re Avandia case; therefore the decision in the Third Circuit stands.

April 19, 2013- The Ninth Circuit affirms the initial decision in the Parra case which found that MAPsMedicare Advantage Plans do not have the same rights to recovery as Medicare does and can recover conditional payments by way of their contract with the beneficiary.

So where are we today? Currently we have two circuits, the Ninth and Third Circuit, which have differing views on MAPMedicare Advantage Plan recovery rights. Both circuits agree that MAPsMedicare Advantage Plans have the right to recover conditional payments; however they disagree as to what extent MAPsMedicare Advantage Plans can utilize that right. We recently had the U.S. Supreme Court deny taking cert in the In Re Avandia case; therefore, even if Parra is appealed to the U.S. Supreme Court, it is unlikely that the Supreme Court will take the case. With the conflict among the circuits, eventually the Supreme Court will need to hear this issue or we will need formal legislation to definitively address the issue.

In the meantime, primary payers would be wise to err on the side of caution and ensure that MAPMedicare Advantage Plan demands are addressed, so as to not risk a private cause of action for double damages. Best practices in this time of uncertainty would be to question the Medicare beneficiary if they are currently or have ever been enrolled in a MAPMedicare Advantage Plan. With that knowledge, the primary payer can at least be aware of any potential conditional payment demands by that MAPMedicare Advantage Plan and seek to reimburse those payments before the risk for double damages sets in. Settlements that occur within the Ninth Circuit where the Parra case was decided is seemingly the only jurisdiction currently not subject to double damages, at least for now.

Based upon recent history, the status of MAPsMedicare Advantage Plans and their recovery rights under the MSPMedicare Secondary Payer Act is certainly going to continue to evolve, and PMSI will continue to stay abreast of any new developments.

Comments (0)

By Settlement Solutions, April 10, 2013 2:50 pm

CMSCenters for Medicare and Medicaid Services held a teleconference regarding MMSEAMedicare Medicaid and SCHIP Extension Act Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting Reporting on April 9, 2013 which pertained to Liability Insurance (including Self-Insurance), No-Fault, and Workers’ Compensation collectively recognized as Non-Group Health Plans (NGHPNon-Group Health Plan - liablity (including self-insurance), no-fault and workers' compensation). During this teleconference, CMSCenters for Medicare and Medicaid Services addressed various topics, including, but not limited to MMSEAMedicare Medicaid and SCHIP Extension Act Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting Reporting, recent MIRMandatory Insurer Reporting alerts, and the implementation of ICD-10International Classification of Diseases, 10th Edition as it relates to reporting.

Please note that this blog only touches on some of the highlights of the CMSCenters for Medicare and Medicaid Services Teleconference¹ and is not all-inclusive of items discussed during the teleconference. CMSCenters for Medicare and Medicaid Services stated that all official guidelines are posted on the Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting web page at www.cmsCenters for Medicare and Medicaid Services.gov/MandatoryInsRep. If there are any conflicts between the documents/information posted on the web site and what is stated on the teleconference, the written documents/information posted on the web site prevail.

A schedule of upcoming teleconferences will be available on the website; there are no future scheduled teleconferences at this time.

CMSCenters for Medicare and Medicaid Services posted an alert on March 24^th regarding data elements that are now optional rather than required. CMSCenters for Medicare and Medicaid Services hopes that it will simplify the process for RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA. The alert is available on the website.

The profile recertification process for RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA has been put on hold temporarily but is scheduled to resume in the near future. Recertification will not occur as it did in 2012 with many RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA going through recertification at the same time. The activity in 2013 will be evenly distributed throughout the year and an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA that recertified in early 2012 may find their 2013 recertification to be later in the calendar year. In 2014, the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA should receive the recertification request on the anniversary of the recertification from 2013. RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA should wait to receive the recertification request before contacting the COBCCoordination of Benefits Contractor.

For technical support, RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA should always utilize the escalation process provided in the NGHPNon-Group Health Plan - liablity (including self-insurance), no-fault and workers' compensation User Guide.

An updated NGHPNon-Group Health Plan - liablity (including self-insurance), no-fault and workers' compensation User Guide is expected to be issued in May 2013. However, most updates will include alerts previously issued and information previously provided by CMSCenters for Medicare and Medicaid Services. The updates to the User Guide will be notated in the first chapter of each section of the User Guide.

Questions submitted to the Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting mailbox

Will CMSCenters for Medicare and Medicaid Services add an ICD-9International Classification of Diseases, 9th Revision code for Instantaneous Death?

CMSCenters for Medicare and Medicaid Services has no current plans to make this an acceptable ICD-9International Classification of Diseases, 9th Revision code. RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA’s will need to follow up and find information about the injuries which lead to the death.

What should an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA do if a query was submitted for a 65 year old individual but the query did not find the individual to be a Medicare beneficiary?

If the individual did not match in CMSCenters for Medicare and Medicaid Services’ system, the individual is likely not a Medicare beneficiary. However, the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA should double check the information being submitted and be sure that the information submitted is accurate. There should be no need for further action by the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA; however, CMSCenters for Medicare and Medicaid Services recommends that the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA do one query on or after the date of settlement due to the fact that the beneficiary may be pending receipt of benefits when initially queried. The RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA can cease querying after they confirmed they are not a beneficiary at the time of settlement.

If an individual is no longer treating, but the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA retains legal responsibility due to the fact that the state does not allow the closure of future medical treatment, how should these claims be reported?

Even if the individual is not currently receiving treatment, it should be treated as an open ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) in the event that the beneficiary may require further treatment. The RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA should not terminate ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) until legal responsibility for future medical treatment is terminated. The fact that an RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA has administratively closed a case does not mean ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) should be terminated.

If a liability settlement occurs that is exactly $5,000, is that currently reportable?

The current liability TPOCTotal Payment Obligation to the Claimant thresholds run from October 1, 2012-September 30, 2013 and only settlements over $5,000 need to be reported. Therefore, if the TPOCTotal Payment Obligation to the Claimant occurred after October 1, 2012 and it was for exactly $5,000 it would not be a reportable claim. However, the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA may voluntarily report the claim.

When will ICD-10International Classification of Diseases, 10th Edition be applied to Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting , and if so, how does CMSCenters for Medicare and Medicaid Services plan to implement ICD-10International Classification of Diseases, 10th Edition?

As of right now, October 1, 2014 is the roll out/go-live date for ICD-10International Classification of Diseases, 10th Edition. CMSCenters for Medicare and Medicaid Services plans to start testing in October 2013 to give the industry a year to get ready for ICD-10International Classification of Diseases, 10th Edition implementation for Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting . CMSCenters for Medicare and Medicaid Services will issue an alert confirming the requirement of ICD-9International Classification of Diseases, 9th Revision versus 10 when they have made a firm decision.

Will CMSCenters for Medicare and Medicaid Services answer questions regarding the SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011 on today’s teleconference call?

No questions regarding the SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011 will be answered. The SMARTStrengthening Medicare and Repaying Taxpayers Act of 2011 ActStrengthening Medicare and Repaying Taxpayers Act of 2011 will be implemented per CMSCenters for Medicare and Medicaid Services timelines and through rulemakings.

Open Question and Answer Session  

Regarding loss of consortium and other derivative claims, if a spouse files and releases “all claims” in a settlement, but the spouse did not make any emotional/physical claim should the “NOINJ” code should be used? Is the claim reportable even if medicals are not part of a wrongful death settlement?

Yes, the “NOINJ” code should be used in this situation, and there is a separate report for each individual-i.e., both spouses should have separate reports. Yes, the claim is still reportable even if medicals are not part of the wrongful death settlement; RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA are not permitted to interpret state laws for CMSCenters for Medicare and Medicaid Services.

In a no-fault claim, if the Statute of Limitations (SOL) has ran, can the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA terminate the ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case)?

Yes, if the no-fault carrier is going to cease payment and will not pay anything after the SOL has expired then the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA can terminate the ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case).

In a liability case where a Medicare beneficiary will require future treatment, but the Plaintiff agrees in writing to pay for their future medical care, will the defendant be subject to future liability by Medicare?

CMSCenters for Medicare and Medicaid Services refused to answer this question and stated that it was “outside the scope of the call.”

With respect to the ANPRMAdvance Notice of Proposed Rulemaking issued last year regarding MSPMedicare Secondary Payer Act and future medicals, is there any sense of timing as to when the industry will receive proposed rules or the agency’s next steps or statements? How will the ANPRMAdvance Notice of Proposed Rulemaking affect defendants?

CMSCenters for Medicare and Medicaid Services also refused to answer this question. They noted that the industry can look for updated announcements in the Federal Register. They also noted that even the people working on CMSCenters for Medicare and Medicaid Services rulemakings often times do not know the day it will be published.

What should RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA do when Medicare beneficiaries are being denied coverage or treatment for items not related to their liability or workers’ compensation case?

CMSCenters for Medicare and Medicaid Services recommends that RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA provide the recent MedLearn article that CMSCenters for Medicare and Medicaid Services issued which makes it clear that an open liability, no-fault or workers’ compensation case is not a basis for a provider denying treatment.

In terms of payment, CMSCenters for Medicare and Medicaid Services does have prompt pay rules, unless there is ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) posted related to the claim. Most cases are denied appropriately; however, the beneficiary can also appeal the denial. The beneficiary can also call 1-800-Medicare or can seek assistance from their local regional office.

If there is a liability policy that also has MedPay, and payments are made incrementally under MedPay, would that be reported as ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case)?

This would be reported as ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case); MedPay is ORMOngoing Responsibility for Medicals (i.e., carrier accepting payment responsiblity for case) since it is a type of no-fault.

With regard to the March 24^th alert, if there are errors that come back from a prior submission and the error is contained within a field that is now “optional” pursuant to the March 24^th alert, should the RREResponsible Reporting Entity - payer subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA disregard the error report or make the correction?

On the next quarterly submission, you can remove your e-code only if it was blank in the first place. However, if information was provided that was incorrect, it should be corrected on the next quarterly submission.

What if a claim was made with ICD-9International Classification of Diseases, 9th Revision codes but becomes reportable after October 2014? How will that be reported to CMSCenters for Medicare and Medicaid Services?

CMSCenters for Medicare and Medicaid Services’ intent is to allow the ICD-9s to continue to be reported; however, this is something that CMSCenters for Medicare and Medicaid Services is looking into. CMSCenters for Medicare and Medicaid Services does not expect people to interpret/transfer ICD-9International Classification of Diseases, 9th Revision to ICD-10International Classification of Diseases, 10th Edition. The goal is to make this as easy as possible for everyone.

^{1. Questions and answers have been paraphrased.
Disclaimer:
This blog is provided as reference material and is based on verbal information derived from third parties during teleconferences hosted by the Centers for Medicare and Medicaid Services (CMSCenters for Medicare and Medicaid Services). PMSI does not assume liability or responsibility for the accuracy or completeness of the material in this document. The information contained herein should not be construed as an endorsement of any kind or an official transcript of the teleconference. PMSI makes no representation or warranties of any kind, either express or implied, that this information is accurate, up-to-date, or error free and PMSI shall not be liable in any amount for any damage, however arising, that may occur as a result of your reliance on this information. This document is advisory in nature only and does not represent official policy, procedures, or opinions of CMSCenters for Medicare and Medicaid Services or PMSI. For official information regarding Section 111Section 111 of the Medicare Medicaid and SCHIP Extension Act stating requirements for mandatory insurer reporting of the Medicare, Medicaid, and SCHIP Extension Act (MMSEAMedicare Medicaid and SCHIP Extension Act), refer to the official web page https://www.cmsCenters for Medicare and Medicaid Services.gov/MandatoryInsRep/.↩}