CMS Posts Updated NGHP User Guide Version 7.0: Starting in July 2023, RREs to Receive Additional Monthly ORM Information
By: Kathy Bell, CPCU, AIC, SCLA, CMSP
Vice President, MSP Compliance
The Centers for Medicare & Medicaid Services (CMS) has posted an update to the MMSEA Section 111 NGHP user Guide version 7.0 Chapter 1: Introduction and Overview. Version 7.0 of the Updated NGHP User Guide can be found here.
Starting July 2023, Responsible Reporting Entities (RREs) can opt in via the Section 111 website to receive monthly NGHP Unsolicited Response File notifications when another source has updated their submitted records. Key information about updates to ORM records originally submitted in the last 12 months will be provided. This will allow RREs to either update their own internal data or contact the Benefits Coordination & Recovery Center (BCRC) for a correction.
Sanderson Firm Commentary: As was noted in the Proposed Rule on Civil Monetary Penalties (CMPs) for Section 111 Reporting issued in February of 2020, if inaccurate information is transmitted, it could cause the RRE to be penalized with CMPs up to $1000 per day/per claim. Another focus area that we saw in the Proposed Rule on CMPs is that CMS plans to penalize RREs with CMPs where they have performed Section 111 reporting as required, but subsequently provide information to CMS or its conditional payment recovery contractors that contradicts reported information in response to MSP recovery efforts.
If Ongoing Responsibility for Medicals (ORM) records are submitted by a source other than the RRE that contradict the information being reported through the Section 111 data, this may potentially expose the RRE to CMPs. This could include changes in the assumption of ORM or termination of ORM without sufficient reasoning.
RREs should investigate any changes to ORM that contradict what the RRE might have in its claim records. Sanderson Firm recommends verifying that the Authorized Representative and Account Manager information in the Section 111 website is updated with current contact information on a regular basis to ensure Section 111 notices are received timely.
The Section 111 MIR Reporting Proposed Rule is currently with the White House OIRA office. The Federal Register continues to indicate a February 2023 release date. Below is a link to its status.
https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202004&RIN=0938-AT86
Sanderson Firm is available to provide guidance on MSP Compliance including Section 111 Mandatory Insurer Reporting (MIR). Please contact me if you have any questions on this update.
