What is CMS Medicare MMSEA, Why Do I Have to Pay Back Medicare?
What is CMS Medicare MMSEA, Why Do I Have to Pay Back Medicare?

CMS MMSEA – the Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers’ Compensation User Guide has been written for use by all Section 111 liability insurance (including self insurance), no-fault insurance, and workers’ compensation Responsible Reporting Entities (RREs). The five chapters of the User Guide—referred to collectively as the “Section 111 NGHP User Guide”—provide information and instructions for the Medicare Secondary Payer (MSP) NGHP reporting requirements mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA)

A detailed explanation of the CMS MMSEA reporting requirements can be found at NGHP User Guide by CMS.

Section 111: • CMS MMSEA Adds reporting rules; it does not eliminate any existing statutory provisions or regulations. • Does not eliminate CMS’s existing processes, including CMS’s process for selfidentifying pending liability insurance (including self-insurance), no-fault insurance, or workers’ compensation claims to CMS’s Benefits Coordination & Recovery Center (BCRC) or the processes for Non-Group Health Plan MSP recoveries, where appropriate. • Includes penalties for noncompliance. Who Must Report: • An applicable plan. • The term “applicable plan” means the following laws, plans, or other arrangements, including the fiduciary or administrator for such law, plan, or arrangement: (i) Liability insurance (including self-insurance). (ii) No-fault insurance. (iii) Workers’ compensation laws or plans. • See 42 U.S.C. 1395y(b)(8)(F).

Overview of Reporting Requirements to Determine Paid by CMS Medicare

New Medicare CMS MMSEA requirements mandate reporting of claims of elder abuse and neglect.  CMS will check the data base for injuries for that particular person related to the date of the injury and/or the injury treatment itself.  This is a complicated area of the law and requires careful coordination with any potential settlement releases and understanding of appeal process to remove unrelated charges and to reduce the eventual amount claimed by the government in the Final Demand from CMS by the proportionate amount of attorney fees and costs.

If you have questions about elder abuse or neglect seek the advice of an experienced attorney.  For a free consultation with Attorney Kenneth LaBore call him directly at 612-743-9048 or by email at KLaBore@MNnursinghomeneglect.com.

What is CMS MMSEA?