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Avoid Anticipated Medicare Mandatory Reporting Penalties

Posted on July 29, 2020 by Tower MSA

Nancy Grover of workerscompensation.com wrote an in-depth article on Tower MSA Partner’s “Avoiding Medicare Mandatory Reporting Penalties” webinar.  CMS is considering comments received to its proposed regulation that included penalties as high as $1,000 per day per claim. Final regs could publish any time. 

“There probably won’t be a lot of changes [in the final rule],” said Tower’s Chief Compliance Officer Dan Anders, who presented the webinar with Jesse Shade, VP of Information Technology.

Penalties could be imposed on organizations for not reporting a claim closure at all, exceeding error tolerance, or reporting contradictory information at different times. The article quoted Anders’ “contradictory information” example of a Medicare beneficiary with work-related injury on his right shoulder and a diagnoses code indicating the injury was on the right knee.

“CMS would have conflicting information. Even if the error is subsequently corrected, CMS could still impose a penalty of up to $365,000 [for a year],” he said.

To avoid penalties from even minor mistakes, Anders recommended that attendees note the omission of data, confirm the correct use of diagnosis codes, be sure to promptly report termination of ongoing responsibility for medicals or ORM.

“And ensure you have a reporting platform that is identifying potential errors and is working with you … to resolve errors and avoid penalties,” he said.

Tower is well positioned to serve as your reporting agent partner.  The company proactively developed its own Section 111 Mandatory Reporting dashboard, which Shade demonstrated on the webinar. He showed the many ways the platform helps users identify possible mistakes, address missing data points, confirm ICD9 and ICD10 codes, and run reports to direct their efforts.   Incorporating all the elements CMS examines, the dashboard simplifies and automates the process for users.

The dashboard is ready to roll as soon as CMS publishes the final regs.  As usual, Tower is ahead of the game — meeting clients’ needs before they know they have them.