Workers’ compensation payers have approximately six months to get their Section 111 reporting houses in order. Tower MSA Partners has introduced a Section 111 reporting audit service to help them do just that.
Starting October 11, 2024, workers’ compensation plans, liability insurance (including self-insurance, no-fault insurance), and Responsible Reporting Entities (RREs), and will be held accountable for the timely reporting of Medicare beneficiary claimants where ongoing responsibility for medicals (ORM) has been accepted, or where a Total Payment Obligation to the Claimant (TPOC) has occurred. Civil Monetary Penalties (CMPs) for untimely reporting of ORM acceptance or TPOC can be thousands of dollars on a single claim.
Tower’s Section 111 reporting audit service detects problems or potential problems in the RRE’s reporting processes that could lead to CMPs due to untimely reporting. It also addresses the issuance of unnecessary Conditional Payment Demands by Medicare’s recovery contractor that occur when ORM Term Dates are not reported as part of TPOC reporting.
“Our compliance experts examine a set of claim input and response and query response files over a set time period and review the organization’s reporting policies and procedures,” said Chief Compliance Officer Daniel Anders. “The audit detects the types of errors, inconsistencies and omissions that hinder compliance and could trigger a reporting penalty.”
Tower goes beyond just identifying problematic processes. Experts collaborate with the RRE to take corrective actions and implement changes to ensure compliance. “It’s not just a snapshot in time,” Anders said. “Changing processes fixes issues for the long term.”
About Tower MSA Partners
Serving clients nationally, Tower MSA Partners provides comprehensive Medicare Secondary Payer compliance services, including Section 111 Mandatory Insurer Reporting, conditional payment resolution, and Medicare Set-Aside optimization and preparation. For more information, please visit www.towermsa.com and subscribe to https://towermsa.com/blog/.
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