CMS Issues Two Important Updates Regarding Liability Insurance
October 17, 2011
CMS Revises Timeline for Certain Liability Insurance TPOC Settlements
According to a September 30, 2011, memo from the Centers for Medicare & Medicare Services (CMS), Section 111 reporting for certain liability insurance (including self-insurance) TPOC settlements, judgments, awards or other payments has been delayed.
The implementation date for reporting will be based on the TPOC amount and starts with TPOC Amounts over $100,000, with a date on or after October 1, 2011, that will require Section 111 reporting in the quarter now beginning January 1, 2012.
The full CMS bulletin and schedule of new reporting dates can be found here.
No other MMSEA Section 111 implementation dates have been changed.
Treating Physician Certification Considered ‘Satisfied’ by CMS For Liability MSAs
In a September 29, 2011, memo, CMS clarified when settlements could be considered ‘satisfied’ related to liability insurance.
Specifically, “when a beneficiary’s physician certifies in writing that treatment for the alleged injury related to the liability insurance (including self-insurance) “settlement” has been completed as of the date of the ‘settlement,’ and that future medical items and/or services for that injury will not be required, Medicare considers its interest, with respect to future medicals for that particular ‘settlement’ satisfied.” An LMSA is not needed for review in this case, according to CMS.
However, if there are other settlements received that are related to the underlying injury or illness, the beneficiary must obtain a separate physician certification for those settlements. An LMSA is not needed for these cases, according to CMS.
Review the CMS memo.
For more information, contact:
Rob Sokol
Director of Medicare Secondary Payer Compliance Services
Allsup, Inc.
r.sokol@allsupinc.com
(866) 202-9333
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