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Medicare Secondary Reporting Requirements

Under the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA), the Centers for Medicare and Medicaid Services (CMS) requires secondary payer reporting from Medicare. This reporting allows CMS to pay the correct amounts for the health insurance to Medicare beneficiaries it should pay. Mandatory reporting has to cover group health plan arrangements, liability insurance including self-insurance, no-fault insurance and worker's compensation. It is meant to assure that if another payer is available and liable, it will pay out before Medicare or Medicaid does.

  1. Quarterly Requirements

    • Since April 1, 2010, responsible reporting entities (RRE) have to make quarterly reports concerning Medicare beneficiaries and claims resulting in resolved medical damages. The reports consist of the judgment or settlement and release regardless if a determination or admission of liability involving the damage claims was made.

    Eligible Injured Party

    • Requirements for Medicare secondary reporting mean that providers have to provide information concerning the eligible injured individual. These reports will have the individual's name, gender, date of birth, Social Security number and health insurance identification number. Additional information concerning the injured party will describe the status of the injury, including the date it happened, description, alleged cause, any relevant ICD-9 diagnosis codes and if the injury was allegedly caused by a product. If the individual believes the injury was caused by a product, RRE will report the product information, any information available concerning the types of insurance and the name of the lawyer representing the injured person.

    Cut-Off Dates

    • Secondary reporting has to state the cut-off dates concerning settlements. Any claim after January 1, 2010 is reported. Any claims before January 1, 2010 do not have to be reported unless the individual is eligible for medical benefits due to the responsible reporting entity (RRE) having ongoing and continuing responsibility toward the caused injury.

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