Medicare Section 111 mandatory reporting update

So, there's a new "stimulus" in town, and it's backed by the fines from CMS for failure to file eligibility reports.  

As you know, section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 ("Section 111") added some mandatory reporting requirements for group health plans ("GHPs")--let's not forget about the "stimulus" for compliance--$1,000 fines PER PERSON PER DAY for failure to report qualifying individuals.  

By the way, the timetable says that GHP's should be registered to begin testing already.  

This is all about Coordination of Benefits ("COB").  The Feds want to be sure that if any other entity is on the hook for reducing Medicare's costs on claims for individuals for which you manage coverage, you're on the hot spot. Furthermore, they're requiring online reports, at least quarterly.  

If your legacy vendor still hasn't given you Medicare COBA crossover claims yet, they'll never meet the deadline.  Getting these claims directly from the federal contractor makes the COB process in your office much easier, and MUCH MORE ACCURATE than waiting for the COB info from the Provider and typing it into your legacy system.  

If you already get COBA files directly, you can bet that your legacy vendor will charge a hefty premium for adding the new Section 111 reports, even though the formats for reporting Section 111 eligibility are very similar to the eligibility submission requirements for COBA.  

Either way, you owe it to yourself to look at SpyGlass. It's a claim system that was made for HIPAA, is fully web-based, and designed to support the market needs of today. It's a true "google era" application.

Check out our PDF summary of Section 111 mandatory reporting along with this commentary. The original document is also available as html online at the CMS' website