Employers, insurers brace for impact

Employers, insurers, and TPAs still getting used to the intricacies of Medicare Set-asides have a new challenge on their hands: understanding the intricacies of Medicare’s recent reporting requirements.

As widely reported, Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) imposes new mandatory reporting requirements on insurers and self-insurers in group health plans, liability insurance, no-fault insurance, and workers’ compensation.

Businesses subject to the Act must report extensive information about the Medicare beneficiary, the claim, and the business itself once there has been a settlement, judgment, award or other payment. These reports must be submitted electronically on a quarterly basis.

The purpose of the requirement is to enable the Centers for Medicare & Medicaid Services to track payments to or on behalf of Medicare beneficiaries, so CMS can ensure Medicare remains a secondary payer and is not billed for charges that should be the responsibility of other parties.

Employers can expect more scrutiny from feds

A recently issued report by the U.S. Government Accountability Office charges physicians and nurses are often pressured by employers to conceal workplace injuries - even if it means providing inadequate medical treatment.

“From its survey of U.S. health practitioners, GAO found that over a third of them had been subjected to such pressure,” the watchdog agency said in its report, titled Workplace Safety and Health: Enhancing OSHA’s Records Audit Process Could Improve the Accuracy of Worker Injury and Illness Data.

The Charlotte Observer reported that in a survey of 504 occupational health practitioners - including company doctors and nurses - the GAO found:

•More than a third said they were asked to provide insufficient treatment to workers so that job-related injuries did not show up on company injury logs.

•More than half said they were pressured by company officials to downplay injuries or illnesses.