ALERT
Change in Reporting Threshold for Certain Liability Settlements, Judgments Awards, or Other Payments
As required by section 202 of the Strengthening Medicare and Repaying Tax Payers Act of 2012 (SMART Act), the Centers for Medicare & Medicaid Services (CMS) has reviewed the costs related to collecting data and determining the amount of Medicare’s recovery claim and has calculated a revised single threshold for physical trauma-based liability insurance settlements. (Note: This threshold does not apply to settlements for alleged ingestion, implantation or exposure cases.)
Based on this information, CMS determined it could establish a threshold of $1000 (significantly greater than the prior threshold of $300), so that, effective February 17, 2014, physical trauma-based liability insurance (including self-insurance) settlements of $1000 or less do not need to be reported and Medicare’s conditional payment amount for these settlements does not need to be repaid.
Information on the methodology used to determine this new threshold is provided at
http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/Alert-Change-in-Reporting-Threshold-for-Certain-Liability-Insurance-including-Self-Insurance-Settlements-Judgments-Awards-or-Other-Payments.pdf
The content of this Alert supersedes the content of the existing Medicare Secondary Payer Mandatory Reporting Non-Group Health Plan User Guide (Version 4.1), and will be incorporated into the next version of the User Guide.
(Note: The CMS will pursue recovery of any demand issued prior to the date of this Alert.)
