The Effect of Thresholds on Mandatory Reporting
Posted December 14, 2016
Last year, CMS announced a change in reporting thresholds to $750 for liability settlements, and advised that it would maintain the $750 threshold for no-fault and workers’ compensation settlements, so long as the insurer or entity does not otherwise have ongoing responsibility for medicals (ORM).
In 2017, CMS issued a number of alerts and announcements, as outlined below:
For Liability Insurance Cases: The mandatory reporting threshold for total payment obligation to the claimant (TPOC) after January 1, 2017, has changed from $1,000 to $750.
Takeaway: If the most recent TPOC date is after January 1, 2017 and the cumulative TPOC amount is greater than $750, the TPOC must be reported.
For No fault Insurance Cases: The mandatory reporting threshold for TPOC amounts dated October 1, 2016 or after, was raised from $0 to $750.
Takeaway: If the most recent TPOC date is after October 1, 2016 and the cumulative TPOC amount is greater than $750, the TPOC must be reported.
For Workers’ Compensation Cases: The mandatory reporting threshold for TPOC amounts dated October 1, 2016 or after changed from $300 to $750.
Takeaway: If the most recent TPOC date is after October 1, 2016, and the cumulative TPOC is greater than $750, the TPOC must be reported.
Another notable change in 2017 is that cases will only be rejected if the case is noted as having no ORM, and for which the total TPOC amount is $0.
What these changes in reporting thresholds mean is that an RRE is not required to report the settlement if the total TPOC amount does not fall within one of the above; nor will CMS seek recovery on cases that do not fall within the thresholds.