MMSEA Compliance

The amendments relating to Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) have important application to primary payers handling worker’s compensation, liability insurance (including self insurance) and no-fault claims. The intent of the amendment is to increase Medicare’s enforcement of the Medicare Secondary Payer Statue by assisting them in addressing the issues of benefit coordination and conditional payment reimbursement. Payers, including self-insured organizations, must determine whether a claimant is entitled to benefits and must determine Medicare and Medicaid entitlement. Since failure to comply can saddle the payer with a severe penalty of $1,000 for each day of non-compliance, understanding these regulations is critical.

SISCO has a comprehensive understanding of the ever-evolving MMSEA Regulations. We offer a full array of services to assist your organization in meeting the query and reporting requirements, keeping abreast of changes as they occur, and assisting with settlement negotiations considering lien exposures.

SISCO’s portfolio of MMSEA services include:

Training and Information: SISCO will provide guidance to internal claims staff and defense counsel regarding compliance in ensuring Center for Medicare and Medicaid Services (CMS) is reimbursed in settlements involving Medicare.

Registration as a Responsible Reporting Entity (RRE): SISCO provides assistance with the RRE registration process and presents training programs to senior management regarding MMSEA compliance.

Claim Discovery and Settlement Negotiation Assistance: SISCO has established effective workflows and processes to ensure compliance with the Medicare Secondary Payer statute. Our claims consultants also provide assistance during settlement negotiations.

Confirmation of Beneficiary Status: We provide access to query CMS to determine the claimant’s beneficiary status.

Claim Reporting: Once a claim is settled, over 130 fields of information are required for reporting to CMS.  SISCO will help clients efficiently and accurately comply with MMSEA.

Keeping Current with MMSEA:  SISCO keeps clients alerted to changes in the law and is available at any time to answer questions and clarify any new directives.