CMS Section 111 Mandatory Reporting: What You Need to Know

Section 111 of the Medicare Extension Act of 2007 added mandatory reporting requirements for Medicare beneficiaries who receive benefits, settlements, judgments, or awards from liability or workers’ compensation claims. While this rule has been around for several years, CMS has indicated its intention to audit and evaluate penalties and fines for those who are noncompliant with reporting.

You may have recently received an email from LHA Trust Funds asking if you would like us to continue reporting on your behalf, and if necessary, assist with process changes and making updates to your CMS Profile report.

To clarify this requirement and demonstrate our commitment to compliance, we answer some basic questions on Section 111 reporting requirements.

Who Must Report?

Each employer or hospital must designate a responsible reporting entity to report any ongoing medical responsibility and/or liability claim payments. This includes liability insurers, workers’ compensation plans, and self-insured entities. An insurance provider may report on a facility or employer’s behalf. However, because it is necessary to report accurate information, we must issue the payments related to the claim if we assume reporting responsibilities.

LHA Trust Funds has expanded our technology by partnering with Examworks to ensure that all data collected and reported is accurate on behalf of any of our members or clients that have contracted with us to handle their CMS Section 111 reporting requirements. Our adjusting staff obtains all the required information during the claim where the data file is verified and reported to CMS.

What if I cannot locate our CMS Annual Profile Report?

If you cannot locate your profile information that was initially set up, it is acceptable to create a new Responsible Reporting Entity Identification.

If LHA Trust Funds is contracted for your CMS reporting, we ask that you send us copies of any communications you receive from CMS regarding your profile registration or updates.

What if I still have questions?

A complete resource from CMS regarding mandatory NGHP reporting can be found here.

If you have questions about using LHA Trust Funds to report on your behalf, please contact Vice President of Claims Operations Jamie Lamb for assistance.