Section 111 Reporting
The Medicare Mandatory Insurer Reporting Requirement (MIR) places a tremendous burden on self-insured entities, insurance carriers and other statutory classified “applicable plans”.
Harbored under, 42 U.S.C §1395y(b)(8) of the Medicare Secondary Payer Statute, the MIR mandates that the carriers, self-insured entity and/or applicable plans, verify the Medicare entitlement of every Claimant. If a Claimant is determined to be a Medicare beneficiary, then the carrier, self-insured or applicable plan must report specifics of qualifying cases to Medicare, during an appropriate reporting quarter, at the time of the claims settlement, judgment or award, or after an ongoing responsibility to pay for medical expenses is established and/or ends.
Failure to comply with their statutorily mandated MIR requirements, can lead to penalties against the carrier, self-insured or applicable plan of $1,000 per day, per non-compliant claim.
The Burns White Medicare Mandatory Insurer Reporting Team works with self-insured entities, third party administrators and insurance carriers on a nationwide basis in dealing with MIR compliance matters. The MIR compliance team assists clients with services that include, but are not limited to:
Serving as an MIR reporting agent
Serving as national coordinating Medicare Insurer Reporting Counsel
Establishing MIR compliance strategies
Assisting with the establishing internal MIR systems
Troubleshooting established MIR systems
Providing legal opinions on the need for MIR compliance
Serving as litigation counsel on discovery and MIR trial matters
With the evolving nature of the Medicare Secondary Payer Statute and the Mandatory Insurer Reporting (MIR) Section 111 requirement, it is imperative that experienced professionals assist in identifying and resolving all of the MIR issues specific to a claim.
Please contact the Medicare Compliance Group to discuss any potential Medicare Section 111 issues that arise in any of your matters or with any questions that you have regarding Medicare Compliance.