PPM Policyholder Alert – New CMS Reporting Requirements
New CMS reporting requirements effective January 1, 2010

Shawnee Mission, KS - January 27, 2010 - Preferred Physicians Medical (PPM), industry leading provider of professional liability insurance for anesthesia practices, reminds PPM policyholders that new CMS reporting requirements went into effect on January 1, 2010.   The new CMS reporting requirements require PPM policyholders and their anesthesia practice groups to report certain payments made directly by the physician or the practice group to settle a claim involving a Medicare beneficiary.

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA Section 111) now requires PPM policyholders and their anesthesia practice groups to report settlements of professional liability claims involving Medicare beneficiaries.  For example, if a PPM policyholder or their anesthesia practice group directly pays (as opposed to PPM paying) a Medicare beneficiary to settle a professional liability claim, the PPM policyholder or anesthesia practice group may (depending on the amount of the settlement) be required to file a report with CMS as a responsible reporting entity (RRE).

There are some exceptions to these reporting requirements.  The current CMS reporting requirements exclude any settlements of $5,000 or less in 2010; $2,000 or less in 2011; and $600 or less after 2011.  The reporting requirements apply to any payments made on or after January 1, 2010, and the first date for a required report is April 1, 2010. Payments in excess of these amounts trigger the reporting requirements.

According to Brian Thomas, Director of Risk Management and Senior Claims Attorney, these new reporting requirements may ultimately discourage physicians and practice groups from attempting to promptly resolve small claims with patients who are Medicare beneficiaries.  "While we hope CMS will ultimately address this concern, PPM believes it is important for its policyholders to be aware of these new reporting requirements."

In response to these new CMS reporting requirements, PPM encourages its policyholders and their anesthesia practice groups who are contemplating making an "out-of-pocket" payment to settle a professional liability claim to contact PPM to determine whether they have a reporting obligation under the new CMS reporting requirements.

PPM will provide a more detailed analysis of the new CMS reporting requirements in an upcoming issue of Anesthesia & the Law.

References

www.cms.hhs.gov/MandatoryInsRep

CMS, "MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting, Liability Insurance (including Self-insured), No-fault Insurance and Workers' Compensation User Guide, Version 2.0" (July 31, 2009).