Health Care Alert
November 2010
Authors:
Mary Beth Johnston
marybeth.johnston@klgates.com
919.466.1181
Amy O. Garrigues
amy.garrigues@klgates.com
919.466.1275
Amy L. Mackin
amy.mackin@klgates.com
919.466.1240
K&L Gates includes lawyers practicing out
of 36 offices located in North America,
Europe, Asia and the Middle East, and
represents numerous GLOBAL 500,
FORTUNE 100, and FTSE 100
corporations, in addition to growth and
middle market companies, entrepreneurs,
capital market participants and public
sector entities. For more information,
visit www.klgates.com.
THIRD UPDATE: Are You Ready? The Clock
is Ticking on MSP Mandatory Reporting
Requirements
The K&L Gates Health Care practice group has issued three prior Alerts addressing
Medicare Secondary Payer Mandatory Reporting for Non-Group Health Plans. Click
here to view the original Alert published on July 9, 2009, here to view the First
Update published on March 25, 2010, and here to view the Second Update published
on June 15, 2010.
The proverbial clock, however, continues to tick. In an Alert dated November 9,
2010, the Centers for Medicare & Medicaid Services announced a revised
implementation timeline for mandatory reporting of payments made to Medicare
beneficiaries by non-group health plans, which include liability insurers (including
self-insurers), no-fault insurers, and workers’ compensation plans. The chart below
summarizes the new reporting timeline.
Liability
Insurance
(including SelfInsurance)
Total Payment to
Beneficiaries (“TPOC”)
Amounts
Ongoing Responsibility for
Medicals (“ORM”)
Reporting begins in first
calendar quarter of 2012,
for TPOCs occurring on or
after October 1, 2011
Reporting begins in first
calendar quarter of 2011, for
ORM existing on or after
January 1, 2010
Earlier reporting is
acceptable
No-Fault
Insurance and
Workers’
Compensation
Reporting begins in first
calendar quarter of 2011,
for TPOCs occurring on or
after October 1, 2010
Reporting begins in first
calendar quarter of 2011, for
ORM existing on or after
January 1, 2010
Health Care Alert
The interim reporting thresholds have also been extended by one calendar year. In particular, certain
workers’ compensation ORMs totaling $750 or less do not have to be reported until January 1, 2013.1 In
addition, liability insurance and workers’ compensation TPOCs only have to be reported if they exceed the
following phase-in thresholds:

$5,000 for claim reports where the most recent TPOC date is on or before December 31, 2012

$2,000 for claim reports where the most recent TPOC date is in calendar year 2013

$600 for claim reports where the most recent TPOC date is in calendar year 2014
Registration is currently open for both the file submission process and the direct data entry (“DDE”) option.
Entities planning to use the file submission process should already be in “testing status,” with reporting
beginning on January 7, 2011 for the claims required in the first quarter of 2011 pursuant to the chart above.
DDE reporting will begin on January 10, 2011.2
Please consult our prior Alerts for detailed explanations of this reporting program. In addition, please note
that the CMS Section 111 website at http://www.cms.gov/mandatoryinsrep has been reorganized and now
includes User Guide 3.1, which was issued July 12, 2010.
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K&L Gates includes lawyers practicing out of 36 offices located in North America, Europe, Asia and the Middle East, and represents numerous
GLOBAL 500, FORTUNE 100, and FTSE 100 corporations, in addition to growth and middle market companies, entrepreneurs, capital market
participants and public sector entities. For more information, visit www.klgates.com.
K&L Gates is comprised of multiple affiliated entities: a limited liability partnership with the full name K&L Gates LLP qualified in Delaware and
maintaining offices throughout the United States, in Berlin and Frankfurt, Germany, in Beijing (K&L Gates LLP Beijing Representative Office), in
Dubai, U.A.E., in Shanghai (K&L Gates LLP Shanghai Representative Office), in Tokyo, and in Singapore; a limited liability partnership (also named
K&L Gates LLP) incorporated in England and maintaining offices in London and Paris; a Taiwan general partnership (K&L Gates) maintaining an
office in Taipei; a Hong Kong general partnership (K&L Gates, Solicitors) maintaining an office in Hong Kong; a Polish limited partnership (K&L
Gates Jamka sp. k.) maintaining an office in Warsaw; and a Delaware limited liability company (K&L Gates Holdings, LLC) maintaining an office in
Moscow. K&L Gates maintains appropriate registrations in the jurisdictions in which its offices are located. A list of the partners or members in each
entity is available for inspection at any K&L Gates office.
This publication is for informational purposes and does not contain or convey legal advice. The information herein should not be used or relied upon
in regard to any particular facts or circumstances without first consulting a lawyer.
©2010 K&L Gates LLP. All Rights Reserved
1
For a list of the other requirements for this exception, see Centers for Medicare & Medicaid Services, MMSEA Section 111
Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and
Workers’ Compensation User Guide 3.1, § 11.4 (July 12, 2010).
2
Entities using the file submission process are assigned a week within the quarter to report their claims, and those using the
DDE option should report each claim within 45 calendar days of the TPOC date or the assumption of ORM.
November 2010
2