CMS Releases Updated NGHP Section 111 User Guide Providing Needed Clarity
Last Updated: 20 Oct 2020
On October 5, 2020 CMS issued an updated version of the of the MMSEA Section 111 NGHP User Guide. The latest version of the User Guide, version 6.0, clarifies the computation of TPOC amounts, confirms the fact that indemnity-only settlements do not need to be reported, and provides an updated list of excluded ICD codes for 2021. These updates come at an opportune time considering the additional information being disseminated regarding Section 111 civil monetary penalties. Further, RREs are questioning their responsibilities over reporting indemnity-only settlements. This exact question was raised on several occasions during this month’s Annual NAMSAP Conference, and in light of potential misinformation being put out by others offering Section 111 services, this clarification comes at a great time.
A full list of the updates made to Version 6.0 of the User Guide is as follows:
- Ch. III of the User Guide added additional information regarding the computation of TPOC Amounts. Specifically, Ch. III Sect. 6.4 (pg. 6-13) now states:
“The computation of the TPOC amount includes, but is not limited to, all Medicare covered and non-covered medical expenses related to the claim(s), indemnity (lost wages, property damages, etc.), attorney fees, set-aside amount (if applicable), payout totals for all annuities rather than cost or present values, settlement advances, lien payments (including repayment of Medicare conditional payments), and amounts forgiven by the carrier/insurer.”
- Ch. III also now includes additional information regarding the reporting of indemnity-only settlements. Specifically, Ch. III Sect. 6.5.1 now states:
“RREs are not required to report liability insurance (including self-insurance) settlements, judgments, awards or other payments for “property damage only” claims which did not claim and/or release medicals or have the effect of releasing medicals. Similarly, “indemnity-only” settlements, which seek to compensate for non-medical damages, should not be reported. The critical variable to consider is whether or not a settlement releases or has the effect of releasing medicals. If it does, regardless of the allocation (or lack thereof), the settlement must be reported.”
- Finally, Ch. V has updated the list of no-fault excluded ICD-10 diagnostic codes for fiscal year 2021.
Version 6.0 of the NCHP Section 111 User Guide can be downloaded here (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-User-Guide/NGHP-User-Guide).
While the speculation continues to grow as to when CMS will complete its review of the public comments received on the advanced notice of proposed rulemaking, and more importantly make any announcement as to where we stand on final regulations regarding the implication of civil monetary penalties, one thing is clear- CMS appears to be moving in the direction of CMPs. Accordingly, it is increasingly important to ensure that your Section 111 reporting program is running efficiently, and you are in compliance with CMS’ current guidance. The best way to ensure compliance is to run an internal audit of your Section 111 data in order to confirm claims meeting all thresholds are being reported accurately and timely, that contradictory information is not being reported, and your reporting is error-free.
We at Allan Koba Compliance Solutions will continue to provide you with the latest updates from CMS on all things MSP compliance. Please contact our internal Section 111 Reporting team at firstname.lastname@example.org to discuss the newest updates to the NGHP User Guide, Civil Monetary Penalties, and how we can assist you with an internal audit and ensure your Section 111 reporting remains compliant.