New Medicare Reporting Requirements for the New YearBy | On Feb 09, 2011
Certain provisions of the Medicare, Medicaid and SCHIP Extension Act of 2007 came into effect with the New Year. Beginning on January 1, 2011, insurers must report any loss payment that is made to a Medicare beneficiary that “does or could” include compensation for medical treatment and ongoing responsibility for medical treatment.
The report must include the identity of the beneficiary of the settlement, along with detailed information relating to the settlement and judgment, or other payment that minimizes any portion of the beneficiary’s health costs.
It is important for employers to be aware of these reporting requirements, because they may be required to report judgments or settlements of employment claims to Medicare. In fact, in those claims where the employee alleges that he or she suffered a physical or emotional injury with related medical expenses, then a judgment or settlement must be reported to Medicare.
So, for example, the report could be required for judgments or settlements in claims of discrimination, harassment, assault, battery, and infliction of emotional distress.
If an employer pays a portion of the judgment or settlement, then the employer is responsible for making the report. If the employer is fully-insured and the insurer pays the entire settlement or judgment, then the insurer is required to make the report.
Of course, these requirements only apply if the employee is a Medicare beneficiary. Medicare beneficiaries include persons 65 or older and persons of any age who (a) have end stage renal disease (kidney disease/dialysis patients), and (b) apply or will potentially apply for Social Security Disability Insurance (“SSDI”). Employees who receive, or will potentially apply for, SSDI may include worker’s compensation claimants who are permanently and totally disabled.