CMS Publishes FAQ Regarding Final Rule Civil Money Penalties
By: Brendon DeSouza
Nearly one month ago, the Centers for Medicare & Medicaid Services (CMS) published its Final Rule regarding Civil Money Penalties (CMPs) in the Federal Register. The Final Rule, which came as an early surprise to many in the Medicare Secondary Payer (MSP) community, specified how and when Group Health Plans (GHPs) and Non-Group Health Plans (NGHPs) would be subject to civil money penalties (CMPs) for failure to satisfy their MSP reporting obligations as required by Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.
Yesterday, CMS published an FAQ Alert (located here) to address their most frequently asked civil money penalty questions. Of note, CMS stated that it would identify and review sampled records “from a source other than Section 111 reporting.” The Final Rule appeared to suggest that CMS would only assess CMPs based upon a randomized audit of Section 111 reporting records submitted by GHPs and NGHPs, which left the impression that GHPs and NGHPs could avoid CMP exposure by simply not reporting a Medicare beneficiary record. CMS’ FAQ now clearly confirms that CMS intends to issue CMPs for 1) not reporting a record, 2) untimely reporting of Total Payment Obligation to the Claimant (TPOC), and 3) untimely reporting of the assumption of Ongoing Responsibility for Medicals (ORM).
CMS’ alert and FAQ also announced that CMS will host a webinar in January 2024 to share additional information regarding CMPs. CMS has not provided a specific date or time for the January 2024 webinar, but we expect CMS to announce more details as we move closer to January. In the interim, we encourage primary payers to review CMS’ newly published FAQ as it addresses many of the same questions we have received at Sanderson Firm.
If you have questions regarding CMS’ FAQ, or if you would like to engage Sanderson Firm for our Section 111 reporting solution and auditing services, please contact us.
