Medicare Section 111
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Section 111 reporting facilitates the centers for medicare medicaid services cms recovery of past medical expenses what are called conditional payments in msp regulations or its refusal to pay future medical costs of medicare beneficiaries who receive nghp or ghp payments for the same bodily injuries or emotional distress.
Medicare section 111. United states department of health and human services. Public law 111 148 consolidating the amendments made by title x of the tension act of 2009 s. Centers for medicare medicaid services.
1790 as enacted in amended form by sec. There is considerable review of background information concerning the history since section 111 of the medicare medicaid and schip extension act of 2007 mmsea was passed. Jun 9 2010 act ppaca.
Since 1980 the msp statute has designated nghps and ghps as primary payers when coordinating benefits with medicare. The proposed regulations address specific criteria as to when cmps will be imposed and specific criteria for when the cmps will not be imposed. Section 111 of the medicare medicaid and schip extension act of 2007 mmsea added mandatory reporting requirements with respect to medicare beneficiaries who have coverage under group health plan ghp arrangements as well as for medicare beneficiaries who receive settlements judgments awards or other payment from liability insurance including self insurance no fault insurance or workers compensation collectively referred to as non group health plan nghp or nghp insurance.
Section 111 nghp rres have the ability to transmit a query file to request information regarding the medicare status of injured parties to help determine whether liability insurance no fault insurance or workers compensation claim information should be reported. Re post february 23 2009 introduction to section 111 mandatory medicare secondary payer reporting pdf home a federal government website managed and paid for by the u s. The purpose of the section 111 reporting process is to enable the centers for medicare medicaid services cms to pay appropriately for medicare covered items and services furnished to medicare beneficiaries by determining primary versus secondary payer responsibility.
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