In 2009, we assembled a multidisciplinary team of attorneys from our Insurance and Health Care practices to address the implementation of new Medicare reporting requirements for liability insurers (including self-insured entities), no-fault carriers, and workers’ compensation plans (collectively, Non-Group Health Plans or NGHPs) under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). Since 1980, the Medicare Secondary Payer (MSP) statute has designated NGHPs and Group Health Plans (GHPs) as primary payers when coordinating benefits with Medicare. “Section 111 reporting” assists the Centers for Medicare & Medicaid Services (CMS) in recovering past or refusing to pay future medical expenses of beneficiaries who receive NGHP payment for the same bodily injuries or emotional distress.
We assist clients in understanding their Section 111 reporting and MSP reimbursement obligations, implementing effective regulatory compliance programs, structuring claims settlement terms, and, when necessary, appealing Medicare reimbursement demands. We work with both domestic and overseas casualty insurers on a full range of matters, including:
- Identifying the correct “responsible reporting entity” (RRE) for settlements involving insured risk pools, self-insured retentions, excess liability insurance, mass torts, and/or trust administration;
- Rejecting CMS’s misclassification of casualty insurance products (e.g., Accident & Health) as GHPs;
- Analyzing the extraterritorial reach of Section 111 to overseas carriers;
- Mediating Section 111 reporting and MSP reimbursement obligations between insured and claimant;
- Negotiating settlement terms that (i) obtain data for Section 111 reporting, (ii) address responsibility for Medicare reimbursement, and (iii) avoid duplicative payment liability to claimant and Medicare;
- Addressing liability for future medical expenses and whether to use, and seek CMS approval for, a Medicare Set-Aside (MSA) arrangement;
- Responding to Medicare reimbursement demands, including litigating administrative appeals;
- Self-reporting compliance challenges, including the misreporting of information; and
- Answering reimbursement demands of Medicare Advantage and Medicare Part D drug plans.
Section 111 Bulletin
Section 111 Bulletin
Our Health Care Practice publishes Section 111 Bulletins that provide timely updates addressing notable Town Hall discussions and other Section 111 developments. To sign up to receive these updates, click here.
For any questions about the Bulletins, please contact, Kathryn Bucher.
“Struck by a Duck:” P&C Insurers Confront New ICD-10 Codes
November 24, 2015
Congress Passes Long-Awaited Reforms To The Medicare Secondary Payer Recovery Process, Including Elimination Of SSN Reporting, But Built-In Regulatory Delays Could Postpone Insurer Relief
January 4, 2013
First Section 111 Town Hall of 2012 Highlights Need for Further Clarification of Reporting Responsibilities and Frustration Over Improper Claim Denials for Which Insurers Are Taking the Heat
February 29, 2012
Section 111 Reporting Apparently Delayed For "Certain" Payments
September 30, 2011
Section 111 Bulletin: CMS Releases Revised NGHP User Guide
September 1, 2011
Section 111 Bulletin: CMS Town Hall Adds To Confusion Over Section 111 Reporting Obligations Of Accident and Health Insurers; Controversy Emerges Over Insurer's "Duty To Protect Medicare's Interests"
April 8, 2011
House Introduces Section 111 Reform Bill—If Enacted, Would Remove SSN Reporting Obligation, Create Safe Harbor Reporting Practices and Require Earlier Notice to Insurers of Final Amount Owed Medicare
March 24, 2011
Related News & Insights
- AlertUpdates on Medicare Recoupment from Casualty InsurersSeptember 18, 2017
- AlertUpping Your Section 111 Game – Medicare Secondary Payer Developments Say It’s TimeJune 21, 2017
- AlertCasualty Insurers And Drug Plans: Medicare Secondary Payer Ties That Bind Under SPARC ActMay 22, 2017
- AlertSummer 2016 Round Up of Section 111 and Medicare Secondary Payer Developments for Liability InsurersAugust 24, 2016