CMS Issues Notice of Medicare Secondary Payer and Certain Civil Money Penalties Final Rule

Today, the Centers for Medicare & Medicaid Services issued an alert that it has finalized the rule specifying how and when it will calculate and impose Civil Money Penalties (CMPs).

The rule applies to group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) who fail to meet their Medicare Secondary Payer (MSP) reporting obligations. The final rule can be found and reviewed in its entirety in the Federal Register.

Effective Dates
The rule is effective as of 60 days following the date of publication (December 11, 2023), but is only applicable one year after publication (October 10, 2024). RREs are expected to be compliant with their Section 111 Mandatory Insurer Reporting requirements no later than October 10, 2024, or non-compliance may result in a CMP.

CMS Guidance
CMS is in the process of developing and publishing additional written guidance related to CMPs. While questions can be sent to the CMS Section 111 Civil Money Penalties mailbox at [email protected], CMS is not responding to questions at this time. Rather, they will use questions and comments that are submitted to  inform outreach and educational materials (including webinar presentations). Additional guidance and updates, including information about CMP-related webinars, will be posted on the Mandatory Insurer Reporting pages on CMS.gov as they are released.

IMPAXX Resources
The IMPAXX team is currently analyzing the details of the final rule and will take a deeper dive into Civil Monetary Penalties and the newly published final rule in a webinar this Thursday, October 12 at  2:00 pm ET.  Following the webinar, we will also be sharing our insights in a blog where we will break down the final rule and the impact it could have on your reporting program.