Medicare Secondary Payer Mandatory Reporting

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GOALS OF THIS GUIDE

Medicare is always a secondary payer to workers’ compensation insurance, and the primary payer must always protect Medicare’s interest. Medicare Set-Aside Arrangements (MSAs), when approved by Medicare, are used to protect the primary payer when settling a claim for future medical expenses. LWCC has had an MSA program in place since 2001. Under the new law, Medicare requires strict reporting to identify money previously paid by Medicare that a primary payer should have paid.

Federal Reporting for All Primary Payers 

  • Group health plans 
  • Liability insurance 
  • No-fault insurance 
  • Workers’ compensation insurance 
  • Includes self-insurance

Who Must Report? 

The responsible reporting entity (RRE) for a claim. This includes but is not limited to: 

  • The insurance carrier where there is policy coverage 
  • The self-insured (SI) entity where the SI makes payments directly to the claimant 
  • The excess or reinsurance carrier where the carrier makes payments directly to the claimant

Penalties for Noncompliance 

  • Failure by an RRE to timely report a claim to Centers for Medicare & Medicaid Services (CMS) has a penalty payment of up to $1,000 per day per claim. 
  • Penalties will be allocated to the SCHIP program, which is the federally funded children’s Medicaid program.

What LWCC Is Doing for You 

LWCC’s program* protects LWCC policyholders if… 

  • The policyholder reports ALL claims to us [even if using the reporting purposes only (RPO) program]. 
  • The policyholder is in compliance with our RPO program. If a policyholder does not report all claims to LWCC or if the policyholder is not in compliance with our RPO program, then the policyholder is acting as a self-insured on those claims and …
  • The policyholder may be the RRE and 
  • The policyholder may be subject to the fines of up to $1,000 per day per claim.


* Applies to LWCC policies only. Does not apply to policies written through a multi-state program or to any other insurance policies.


Additional Information 

LWCC contacts for additional information on Medicare reporting: 

Russell Charbonnet, Claims Technical Specialist

rcharbon@lwcc.com

225-231-0785

Nikki Lawhon, Claims Operations Manager

nlawhon@lwcc.com

225-231-0528

Jill Leonard, Assistant Vice President, Claims

jleonard@lwcc.com 

225-231-0805

Paul Buffone, Senior Vice President, Chief Claims Officer

pbuffone@lwcc.com 

225-231-0543

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