Medicare Secondary Payer and Certain Civil Money Penalties: Notice of Final Rule
Summary
CMS has finalized its rule specifying how and when CMS will calculate and impose civil money penalties ("CMPs") when group health plan ("GHP") and non-group health plan ("NGHP") responsible reporting entities ("RREs") fail to meet their Medicare Secondary Payer ("MSP") reporting obligations. The text of the final rule can be found and reviewed in its entirety in the Federal Register, which can be found at https://www.federalregister.gov.
Effective Dates
Please note that this rule is effective as of 60 days following the date of publication (December 11, 2023) but is only applicable one year after publication (October 10, 2024). RREs are expected to be compliant with their Section 111 Mandatory Insurer Reporting requirements no later than October 10, 2024, or they may be eligible for a CMP.
Additional Information
RREs should review the published rule and take time to evaluate their reporting processes to ensure the RRE is compliant with all reporting requirements before the rule goes into effect. If RREs have any questions or concerns about their reporting, they should contact their EDI representative.
We know that CMPs are of great interest to RREs, and CMS is in the process of developing and publishing additional written guidance related to CMPs. Questions should be directed to the new CMS Section 111 Civil Money Penalties mailbox at Sec111CMP@cms.hhs.gov. Please be aware that responses should not be anticipated at this time; CMS will use these questions and comments to help inform outreach and educational materials (including webinar presentations). RREs should continue to monitor the Mandatory Insurer Reporting pages on CMS.gov where additional guidance and updates, including information about CMP-related webinars, will be posted.