On October 11, 2023, the Centers for Medicare & Medicaid Services (CMS) published a finalized rule detailing the imposition of civil monetary penalties (CMPs) for Medicare secondary payers (MSPs) who fail to report required information within the set timeframes. This Rule applies not only to Group Health Plan (GHP) responsible reporting entities (RREs) but also to Non-Group Health Plan (NGHP) RREs.
Medicare Secondary Payers are insurance programs that serve as a secondary coverage source when an individual possesses more than one form of insurance. The primary insurer will first cover medical expenses, with MSPs coming in to cover any additional costs not met by the primary insurer. Therefore, the communication between MSPs and the CMS is crucial for the smooth operation of the system.
The late reporting of necessary information by MSPs can lead to financial penalties, or CMPs. These penalties were introduced to encourage punctual and accurate reporting from MSPs, in order to effectively coordinate benefits and identify instances where Medicare should not have made primary payment.
With this final rule, CMS offers clearer directives regarding how and when these CMPs will be imposed. By implementing a well-defined set of rules, they seek to encourage timeliness and accuracy in the reporting duties of MSPs — benefiting not just the institutions involved, but the patients they serve as well.
King & Spalding, a reputable law firm specializing in health law, have provided an indepth commentary on this new rule, which can be found here. This commentary provides helpful insights into the implications of the rule for MSPs. It will be interesting to observe how these changes will influence the community’s compliance with data reporting commitments, along with what adjustments the CMS might implement based on these trends.