Helping Employers Comply With New MMSEA Regulations is Goal of RIMS 2010 Presentation Planned by Avizent, MEDVAL and Compass USA

COLUMBUS, Ohio, April 20 /PRNewswire/ -- Complying with the new claim reporting requirements in the Medicare, Medicaid and State Children's Health Insurance Program (SCHIP) Extension Act is quickly becoming one of the primary headaches facing workers' compensation, liability and auto no-fault claims handlers, insurers, risk managers and employers. While the good news is there is yet another extension – official reporting does not begin until January 1, 2011 – businesses continue to be concerned about preparing for reporting changes and avoiding fines.

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To help employers and insurance providers understand and comply with the new laws, a presentation entitled "Dipping Into the World of SCHIP Reporting: Where We Are Today" is planned during this year's Risk and Insurance Management Society (RIMS) Annual Conference & Exhibition to be held April 25–29 in Boston.  The presentation will be given by John D'Alusio, ARM, SCLA, Executive Vice President of Claims at Avizent; Ryan Roth, President of MEDVAL, LLC; and Paulette Chapman, MSCC, AIC, Workers' Compensation Legacy Claims Supervisor at Compass USA.

Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) mandates that certain Responsible Reporting Entities (RREs) report quarterly to the Department of Health and Human Services' subsidiary, the Centers for Medicare and Medicaid Services (CMS), for non-group health plans for liability insurance (including self-insurance), no-fault insurance and workers' compensation (in situations where the injured person is Medicare-entitled). The new law also includes significant penalties for late claims reporting in the amount of $1,000 per day, per file not in compliance.

The changes will affect millions of claims each year, and businesses nationwide are scrambling to develop the programs and systems to help them ensure compliance and avoid fines.  The presentation, which will take place on April 27 at 10:45 a.m., will give attendees a chance to learn the steps they need to take to be sure claims are reported according to MMSEA requirements.  They will also learn how to build reporting capabilities into their processes, identify pitfalls and common mistakes, and develop strategies to ensure compliance.

In previous years, MMSEA presentations have been among the most widely attended at RIMS. This year, with deadlines looming and industry professionals seeking answers, an even higher turnout is expected.  "When our clients call us, the first question is: Are you ready for the new MMSEA reporting requirements? And the next question is: What do I have to do to make sure my company doesn't get fined?" said D'Alusio.  "I stress the importance of studying the law, taking advantage of the many resources offered by CMS, and making sure you have the right consultants and partners – don't just blindly read an article and expect to learn everything you need to know.  If you get this wrong, the stakes are very high."

For example, in December of 2009, the U.S. government filed the first-of-its-kind lawsuit against all parties that settled a pollution liability case and neglected to inform Medicare.  The lawsuit seeks money from a $300 million global settlement reached in 2003.  The plaintiff (CMS) will seek double indemnity (allowed by the statute) on any right of recovery due under the law.

While understanding the penalties, many plan sponsors remain unsure of how to avoid noncompliance. Several issues are still to be resolved including how to handle tort reform, bankruptcy, self-insurance pools and subrogation.  In addition, there remains confusion about who qualifies and can report to Medicare as an RRE.

"We are still dealing with a moving target with regard to MMSEA," said Chapman.  "We've got carriers and administrators that can't decide who will be the RRE.  Even when RREs are known, there will likely be confusion as multiple defendants equal multiple RREs; as well as multiple reports of the same settlement, judgment, award, or other payment.  There's still much to finalize."

Roth points out that there are many other potential pitfalls for employers.  "Even if you didn't realize you had an employee who qualified for Medicare, you could still get penalized," he notes.  "That's why it is critical to have vendor partners who know and understand the law, and are prepared to help you implement penalty-proof programs."

"It's going to be a wild ride," states Avizent's D'Alusio.  "Stay tuned – watch the CMS website, attend the online town hall meetings and make sure to connect with providers who know what they are doing."

About Avizent

Avizent, based in Columbus, Ohio, is one of the most innovative claims and risk management service providers in the United States. They offer client-defined solutions in claims management, managed care, alternative risk and risk management information systems. The company has over 40 locations nationwide. For additional information, visit www.avizentrisk.com or call 888-646-9675. You can also follow Thomas Watson, Avizent's CEO, on Twitter at TWatson_Avizent.

SOURCE Avizent