Key Takeaways from CMS’ September Section 111 Reporting Q&A Webinar
Yesterday, the Centers for Medicare & Medicaid Services (CMS) hosted a Section 111 Non-Group Health Plan (NGHP) reporting webinar regarding best practices, reminders, and upcoming changes. In the opening remarks, CMS representatives stated that this webinar was not intended to discuss the upcoming Section 111 reporting civil money penalties; however, representatives confirmed that CMS will host a dedicated Section 111 reporting civil money penalty webinar on an unspecified date next month.
Here are a few key takeaways and reminders from yesterday’s webinar:
1. NGHP Total Payment Obligation to the Claimant (TPOC) settlement, judgements, awards, or other payments are reportable when:
· The alleged injured/harmed individual to or on whose behalf payment will be made has been identified;
· The TPOC amount has been determined; and
· The Responsible Reporting Entity (RRE) knows when the TPOC will be funded or disbursed to the individual or their representative.
2. “Indemnity-only” settlements are not reportable.
· Example provided by CMS: Sue settles her case for $10,000 in lost wages. Sue’s settlement for medical bills is pending. The $10,000 in lost wages is not reported as a TPOC.
3. Claim Injury Error Codes (e.g., C105 – diagnosis code and C103 – alleged cause of injury) are among the most common Section 111 reporting error codes. Please refer to our prior blog discussing these common error codes, linked here.
4. CMS’ expansion of Section 111 TPOC reporting regarding Workers’ Compensation Medicare Set-Asides (WCMSA) for Medicare beneficiaries becomes effective on April 4, 2025.
· Reporting WCMSA information will be required regardless of the total settlement amount value (e.g., even in claims where the Medicare beneficiary will receive less than $25,000, WCMSA information must be reported to CMS via Section 111 TPOC reporting).
5. Civil money penalties become effective in less than one month – October 11, 2024!
Although yesterday’s webinar served as an overall review of Section 111 reporting best practices, reminders, and upcoming changes, civil money penalties were not specifically addressed in detail. We look forward to CMS’ upcoming October civil money penalties webinar, and we will notify our readers as soon as CMS formally announces this webinar date. If you or your organization have questions about Section 111 reporting requirements or are interested in our Section 111 reporting solution (SandersonComply), please contact us.
