Tag Archives: MMSEA

2016 Budget Proposal Would Require Reporting of Workers’ Compensation Benefits to Social Security Administration

heatherThe Social Security Administration (SSA) has been vocal in the past about its difficulty in obtaining information about workers’ compensation benefits. The primary reason that the SSA has been seeking this information is to reduce social security benefits by way of an SSDI/WC offset. The SSDI/WC offset is a calculation used by the SSA to reduce a beneficiary’s SSDI benefit amount if the person is also receiving workers’ compensation benefits. The SSDI/WC offset is different in every state and applies only when the individual’s combined monthly amounts of SSDI and workers’ compensation are greater than 80% of individual’s pre-disability “average current earnings.”

The SSA currently has to rely on beneficiaries to report to the SSA when they receive workers’ compensation or public disability benefits. President Obama’s 2016 budget proposal includes a provision to establish a new federal requirement that workers’ compensation and public disability benefit information be provided by states, local governments, and private insurers to the SSA.

The budget proposal summary includes the narrative below:

Establish Workers’ Compensation Information Reporting. Current law requires SSA to reduce an individual’s Disability Insurance (DI) benefit if he or she receives workers’ compensation (WC) or public disability benefits (PDB). SSA currently relies upon beneficiaries to report when they receive these benefits. This proposal would improve program integrity by requiring states, local governments, and private insurers that administer WC and PDB to provide this information to SSA. Furthermore, this proposal would provide for the development and implementation of a system to collect such information from states, local governments, and insurers.

The proposal can be found here: http://www.ssa.gov/budget/FY16Files/2016BO.pdf (the workers’ compensation reporting proposal can be found on page 22, section 10 of the document).

In summary, ultimately the proposal’s objective is to have states, local governments and insurers report SSDI beneficiaries to the SSA so that it can use the SSDI offset in more cases and ultimately preserve the fiscal integrity of the Social Security program.

This SSA reporting proposal might be giving payers déjà vu of the ultimate goal of MMSEA Section 111, which is to reduce the shifting of the burden to Medicare and so that Medicare can recoup more conditional payments.

Ultimately, the SSA and Medicare have the same end goal, which is saving money and preserving their respective SSA and Medicare programs. Helios would hope that if this SSA reporting proposal becomes a reality that the SSA and Medicare would solidify these efforts into a single reporting solution/requirement since the SSA and Medicare will often be receiving duplicative data.

Helios will be following this reporting proposal and will keep subscribers apprised of any further progress on this proposal.

CMS Releases Technical Alert for Implementation of 5 Digit SSN Changes

Frank FairchokCMS has released a technical alert dated November 25, 2014, related to the implementation of changes to allow beneficiaries to be queried and reported using the last five digits of the SSN. CMS announced the change on September 10, 2014, and this technical alert has been pending since the announcement.

CMS presents the “Background” to this technical alert as follows:

“Effective January 5, 2015, where a NGHP RRE cannot obtain an individual’s HICN or full SSN, the RRE may report the last 5 digits of the individual’s SSN, first initial, surname, date of birth, and gender. NGHP RREs may continue to submit the HICN or full SSN as before without making any changes to the field and file formats. Additionally, the full HICN will continue to be returned if a distinct match to a beneficiary is found, regardless of whether a full or partial SSN was submitted.”

Some important points related to the technical details of this change are defined in the alert as follows:

  • Query Input File (Field 6 – SSN) – To report a partial SSN, fill the first 4 positions with spaces, followed by the last 5 digits of the SSN.
  • Query Response File (Field 6 – SSN) – If the RRE submitted an SSN on the Query Input File, the value returned on the response file will be the same value that was submitted (i.e., either the partial 5-digit SSN or full 9-digit SSN).
  • Query Response File (Field 8 – Disposition Code) – A new Disposition Code “DP” has been added as a value for this field. Disposition Code “DP” will be returned if multiple Medicare beneficiary records were identified based upon the partial SSN and data submitted on the Query Input File.
  • Claim Input File (Field 5 – Injured Party SSN) – To report a partial SSN, fill the first 4 positions with spaces, followed by the last 5 digits of the SSN.
  • Claim Response File (Field 5 – Submitted Injured Party SSN) – If the RRE submitted an SSN on the Claim Input File, the value returned on the response file will be the same value that was submitted (i.e. either the partial 5-digit SSN or full 9-digit SSN).
  • Claim Response File (Field 27 – Applied Disposition Code) – A new Disposition Code “DP” has been added as a value for this field. Disposition Code “DP” will be returned if multiple Medicare beneficiary records were identified based upon the partial SSN and data submitted on the Claim Input File.

The alert also notes that a new version of HEW (HIPAA Eligibility Wrapper) software, version 3.1.0, will be available on January 5, 2014, and that entities using their own X12 translator will need to obtain the revised X12 270/271 companion guide to accommodate revisions to the query input and response files.

For Helios clients, the technical changes encompassed in this alert will be handled almost entirely within MedicareConnect. All input paths for MedicareConnect, whether through file feed or manual input, allow for partial SSNs within the claim record. We encourage our clients and data sources to contact us directly with any specific concerns and to participate in the recently announced Town Hall conference call.

Of particular note to processes specific to our RRE, carrier and TPA clients, CMS has modified the model language for the collection of the SSN with wording to indicate that the last five digits may be provided if the claimant is uncomfortable providing the whole SSN. The revised model language may be obtained here.

For more information, please contact Frank Fairchok, Senior Manager of MedicareConnect at Frank.Fairchok@helioscomp.com.

CMS Announces Town Hall Conference for NGHP Section 111

Frank FairchokCMS has announced a Town Hall teleconference event for Non-Group Health Plans scheduled for December 10, 2014 from 1:00 PM to 3:00 PM Eastern time. This call will discuss both policy and technical details for Section 111 reporting, including the following topics:

  • Reporting Partial Social Security Numbers
  • Response File Naming Convention Change
  • Multi Factor Authentication for the MSPRP

The call in number for the event is (800) 837-1935 with a pass code of “Section 111.” Participants are encouraged to submit questions as soon as possible to the following e-mail address: PL110-173SEC111-comments@cms.hhs.gov

Helios will participate in the call and provide our clients with a summary of the discussion points shortly thereafter.

This announcement can be found here (PDF File).

For more information, please contact Frank Fairchok, Senior Manager of MedicareConnect at Frank.Fairchok@helioscomp.com.

CMS Releases Alert for Changes to Response File Naming Convention

CMS has released an alert dated October 27, 2014 detailing changes to the naming convention for claim, TIN and query response files that will take effect April 6, 2015. In order to ensure that filenames remain unique, CMS is modifying the time, or “T,” node of the filename convention. Instead of four digits representing seconds and centiseconds, a number from 0000 to 9999 will be inserted in the filename.

CMS had recently enabled this change in their production systems and it was detected by the Helios Section 111 reporting platform, MedicareConnect. After Helios brought the matter to CMS’s attention, and reminding them that the response file specification was published in the User Guide, CMS agreed to revert back to the previous coding and publish an alert to provide the normal six months of advance notice.

The full alert can be found at the following address: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/Response-File-Naming-Convention-for-Liability-Insurance.pdf

For more information, please contact Frank Fairchok, Senior Manager of MedicareConnect at Frank.Fairchok@Helioscomp.com.