MMSEA Reporting – What Data Points Will RREs Report?

When you write a Medicare lien dispute it’s important to know where the MSPRC gets its information.  It’s just as important to know that there really isn’t a way to perform a Medicare lien negotiation.

So just how does Medicare get it’s information about your cases?

Before Section 111 & MMSEA Implementation

Before October 1, 2010 (and thus, before Responsible Reporting Entity [“RRE”] is slated to begin) the MSPRC has just two ways of gathering information for Medicare liens.

First, the plaintiff’s attorney reports the case to the COBC with a basic description of the injury.  Then, during the lien resolution process, that same attorney will give additional information via phone calls or letters while attempting to resolve the lien.

Second, the MSPRC is able to review all billing codes when compiling the lien.  Its agents can utilize these codes to build a picture of each hospitalization.   Unfortunately, these codes rarely tell the entire story.  That is why you need to be precise in your lien resolution methods.

After Section 111 & MMSEA Implementation: The 50 Data Points

For all cases settled or closed after October 1, 2010, RREs will report certain information to the MSPRC.  This information has become known as the 50 Data Points (even though it can extend to more than 100).

These data points will fit under umbrella groups, including:

  1. Injured party/Beneficiary data;
  2. Primary plan (defense) data;
  3. Injured party/Beneficiary’s attorney data;
  4. Incident data; and
  5. Settlement data.

The fourth group, “incident data,” will become extremely important to closing a case and distributing funds.   Plaintiff’s attorneys will need someone in their office to communicate with the defense attorneys to make sure that the appropriate ICD-9 codes are reported as incident data.  Otherwise the MMSEA could cause headaches and settlement delays.

As always: be careful and prepare.  Hard work and time spent will help to avoid settlement delays or worse – MSPRC fines of double damages plus interest.

For a complete list of data points please follow the preceding link, or go to http://lienresolutionusa.com/resources-and-links/.

Ryan J. Weiner
Co-Founder Lien Resolution Services
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

3 comments on “MMSEA Reporting – What Data Points Will RREs Report?

  1. […] through Section 111 reporting, and where the plaintiff has not reported settlement.  Keep in mind mandatory reporting does not begin until October 1, 2010, however, permissive reporting remains in effect […]

  2. […] become Responsible Reporting Entities (“RREs”).  This means that they are required to query the Medicare system of the Coordination of Benefits Contractor (“COBC”) to determine if a plaintiff was or […]

  3. […] If the query comes back negative, the reporting obligation is fulfilled, and settlement should progress with fewer concerns.  However, if the query comes back positive, the Medicare lien will hang over all parties’ until resolved.  Following settlement, and with no relation to the plaintiff’s resolution of a lien, the RRE must report the settlement to Medicare.  RREs will report at least 50 data points to Medicare.  They might have to report more than 100 data points in some situations.  For more on the data points, please visit our previous blog entry: MMSEA Reporting – What Data Points Will RREs Report. […]

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