Section 111 Reporting Archives

CMS Webinar Clarifies WCMSA Reporting Rules

April 22, 2026

In an April 15, 2026, webinar, Centers for Medicare and Medicaid Services (CMS) staff discussed important clarifications that will materially impact how Workers’ Compensation Medicare Set-Asides (WCMSAs) are reported under Section 111.

Several of these comments go beyond technical guidance—they directly affect whether CMS will review a WCMSA at all, how settlements are interpreted, and how Medicare coordinates benefits post-settlement.

Below are the most important takeaways, along with what they mean in practice for payers, TPAs, and Responsible Reporting Entities (RREs). A copy of the CMS slides can be found here.

Why Section 111 Reporting Now Drives WCMSA Outcomes

CMS is increasingly using Section 111 reporting as a primary enforcement tool for post-settlement compliance and coordination of benefits.

As a result, reporting errors now create direct financial and compliance exposure. They may:

Eliminate the opportunity for CMS WCMSA review
Trigger incorrect Medicare denials
Create duplicate or inaccurate records in CMS systems
Increase exposure for both payers and claimants

WCMSA preparation, settlement strategy, and Section 111 reporting must now operate as a coordinated process.

TPOC Reporting Before WCMSA Approval Ends Review

The most significant takeaway from the webinar is this:

Reporting TPOC with an MSA amount before CMS approval will effectively end the WCMSA review process. CMS explained that Section 111 reporting is treated as the payer’s definitive representation of settlement posture. Once TPOC is reported with an MSA amount, CMS assumes the parties have elected a non-submit MSA strategy and will not reopen the matter for review.

CMS clarified that:

If TPOC is reported with a WCMSA amount, the Workers’ Compensation Review Contractor (WCRC) will not accept a new submission
If a WCMSA is already under review, the WCRC will close the file without issuing a determination

CMS’s position is that reporting TPOC signals the claim has settled and the parties have chosen to proceed with a non-submit MSA.

Key Risk

Reporting TPOC prematurely permanently removes the ability to obtain CMS approval, even if approval was originally planned.

CMS WCMSA Reporting Requirements You Cannot Ignore

Professional Administrator EIN Reporting

While the professional administrator’s EIN is technically optional, CMS made clear that even if there is an MSA professional administrator, failing to report it will result in the MSA being treated as self-administered.

Why it matters:

When misclassified as self-administered, CMS systems generate beneficiary correspondence that may conflict with the actual trust or professional administration arrangement, increasing beneficiary confusion and compliance disputes

Case Control Number (CCN) Requirements

For CMS-approved WCMSAs, the Case Control Number (CCN) must be reported, even though optional.

Why it matters:

Because CCNs are only assigned to CMS-approved WCMSAs, their absence in reporting is a key indicator to CMS systems that an MSA was not reviewed

Funding Method Must Match CMS Approval

CMS emphasized that the reported funding method must align exactly with the approval:

Lump sum approvals must be reported as lump sum
Structured approvals must be reported as structured

Any change to funding requires CMS approval before reporting.

CMS Introducing Tolerance for Minor Value Differences

CMS acknowledged that small discrepancies can occur between approved MSA amounts and reported values.

To address this, CMS has:

Eliminated sensitivity to cents
Introduced a tolerance threshold for minor variances

This reduces technical errors, but material discrepancies will still create issues.

WCMSA Reporting for Multiple Dates of Injury

CMS maintains its position on multi-date-of-injury settlements:

Report one TPOC and one WCMSA tied to the earliest date of injury
Since the WCMSA covers all settling dates of injury, include all diagnosis codes associated with all settled injuries under that earliest date

Additional dates of injury should still be reported, but with:

$0 WCMSA amounts

For example, if a settlement resolves three dates of injury, one claim should report the earliest DOI with the full WCMSA amount and all applicable diagnoses, while the remaining two claims are reported with zero-dollar WCMSAs

Common Section 111 Reporting Mistakes That Create Risk

CMS reinforced several expectations that, in practice, are common failure points:

Report only after the settlement is finalized*

Reporting a “pending” settlement date remains unacceptable

Ensure data accuracy across all systems

Misalignment between MSA vendors, claims teams, and reporting units is a frequent issue

Populate all applicable fields

“Optional” fields often drive how CMS classifies and processes the MSA. As such, some “optional” fields should be considered required.

*Finalized means all settlement terms are fully executed, court approval if needed, medicals released, and no further contingencies remain.

The consistent theme: incomplete or inconsistent data leads to downstream problems for both payers and beneficiaries.

How to Adjust Your WCMSA and Section 111 Process Now

Organizations should take immediate steps to align their processes with this guidance:

Do not report TPOC until WCMSA approval is obtained (if approval is being sought) and settlement is made final
Always include the CCN for CMS-approved MSAs
Treat the professional administrator EIN as required when applicable
Validate funding method and amounts before submission to ensure they match CMS approval
Implement controls for settlements with multiple dates-of-injury to ensure proper consolidation of diagnoses and reporting structure

Final Takeaway: Section 111 Is Now a Compliance Gatekeeper

CMS is increasing its reliance on Section 111 reporting to drive compliance and post-settlement enforcement.

Organizations that treat WCMSA approval, settlement negotiations, and reporting as separate workflows are at increasing risk of irreversible errors, particularly when TPOC is reported too early.

Getting this right now requires tighter coordination, stronger internal controls, and a more deliberate approach to settlement and reporting timing.

Tower MSA Partners helps organizations align WCMSA strategy with Section 111 reporting to reduce risk and improve outcomes. Contact our team to review your process. Please reach out to Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com with any questions.

Frequently Asked Questions

When should TPOC be reported for a WCMSA?

TPOC should be reported only after the settlement is finalized and medicals released (Indemnity-only settlements are not reported). If a WCMSA is being submitted for CMS approval, TPOC should not be reported until after that approval is received. Reporting too early can prevent CMS from reviewing the WCMSA.

What happens if TPOC is reported before CMS approval?

If TPOC is reported with a WCMSA amount before CMS approval, the review process will be terminated. CMS will not issue a determination, and the opportunity for approval is lost.

Is the professional administrator EIN required for WCMSA reporting?

While the EIN is technically optional, CMS may treat the MSA as self-administered if it is not reported. This can lead to incorrect assumptions about how the MSA will be managed and may impact communication with the beneficiary.

What is a CCN in WCMSA reporting

CMS assigns the Case Control Number to track approved WCMSAs. It must be included in Section 111 reporting to ensure accurate recordkeeping and proper coordination of benefits.

How does CMS manage multiple dates of injury in WCMSA reporting?

CMS requires one WCMSA to be reported and tied to the earliest date of injury. All related diagnoses for the settled injuries should be included under that claim. Additional dates of injury should still be reported, but with zero WCMSA amounts.

CMS will host a webinar on WCMSA Reporting on April 15

March 14, 2026

CMS will host a webinar on WCMSA reporting on March 25, 2026 at 1:00 p.m. ET to review reporting requirements, common issues, and best practices.

The Centers for Medicare and Medicaid Services will host a webinar on Workers’ Compensation Medicare Set-Aside (WCMSA) Reporting on Wednesday, April 15, 2026, at 1:00 p.m. ET.

Per CMS:

CMS will be hosting a WCMSA Reporting Webinar. The intent of the webinar is to review

the WCMSA reporting process that was implemented in April 2025, discuss some of the

issues encountered from CMS’ perspective, and review WCMSA reporting best practices.

As parties impacted by the WCMSA reporting, we also welcome anyone else involved in

the submission and administration of WCMSAs, including attorneys and Medicare

beneficiaries, to join. Please bear in mind that this Webinar is intended to broadly address

the WCMSA reporting process and questions regarding specific cases are not appropriate

for this setting.

There is no pre-registration for the webinar. Full details, including instructions on how to submit questions before the webinar, are available here and in the “What’s New” section of the CMS website.

Key Takeaways from CMS Webinar on Civil Money Penalties

January 21, 2026

On January 15, 2026, CMS held a webinar on Civil Money Penalties (CMPs) for Non-Group Health Plan (NGHP) Section 111 Reporting. This was CMS’s final update before the first audits and penalty notices in the first quarter of 2026. Given that penalties can be substantial and impact an organization’s compliance record, understanding these requirements and deadlines is essential for all Responsible Reporting Entities (RREs).

CMS provides a full explanation of its CMP policy on its website here.

Quick Reference: Critical Dates

February 2026: First CMS audits begin
March 2026: First penalty notices expected
July 2026: Workers’ compensation penalty assessments begin

Audits

CMS will conduct its first audits in February 2026. The audit will randomly select 250 records from all accepted Section 111 records and non-Section 111 records obtained through CMS’s coordination of benefits and data collection methods. The 250 records will proportionally represent both NGHP and Group Health Plan (GHP) records from the prior quarter.

For the February 2026 audit, CMS will evaluate records accepted between October 11, 2025, and December 31, 2025. CMS will look forOngoing Responsibility for Meedicals (ORM) assumptions or Total Payment Obligation to the Claimant (TPOC)(TPOC) reported more than 365 days after the reportable event. This applies to ORM assumptions and TPOC dates of October 11, 2024, or later.

What Triggers Penalties

Penalties are assessed when RREs fail to report required information within mandated timeframes. Specifically, CMS looks for:

ORM assumptions reported more than 365 days after the reportable event
TPOCs reported more than 365 days after the reportable event

Special Consideration for Workers’ Compensation

As a result of the implementation of WCMSA reporting in April 2025, CMS announced that it will not assess penalties for late-reported workers’ compensation TPOCs until July 2026, with a lookback period to July 2025 instead of October 11, 2024. This grace period allows RREs to adjust to the new WCMSA reporting requirements.

Safe Harbor Protection

CMS provides a safe harbor when an RRE cannot report a TPOC because the claimant failed to provide information necessary to identify them as a Medicare beneficiary (such as their Social Security number).

Requirements to qualify for safe harbor:

Make two attempts to obtain the information from both the beneficiary and their attorney by mail or email
Make one additional attempt to either the beneficiary or their attorney by phone, mail, or email
Document all attempts with dates, methods, and responses
If either the claimant or their attorney provides a written refusal to cooperate, no further attempts are needed

Important notes:

Federal law does not prohibit the RRE from contacting the claimant directly, even when the claimant is represented by an attorney
Contact must be made with both the attorney and the claimant until one of them either provides the information or provides a written refusal

All documentation of these attempts must be retained and provided to CMS if a penalty arises.

Acceptable documentation includes copies of emails, certified mail receipts, phone logs with dates and summaries of conversations, and written refusals.

Penalty Notice Process

Informal Notice

CMS expects the first penalty notices to be sent in March 2026. These informal notices will be mailed to the RRE’s Authorized Representative, with a copy to the Account Manager. Importantly, the reporting agent (such as Tower or other third-party administrators) will not be copied on the notice.

Action required:

Given the importance of receiving these notices, RREs should immediately verify that their Profile Report contains up-to-date contact information for both the Authorized Representative and Account Manager.

Upon receipt of an informal notice, the RRE has 30 days to provide a response, including a reasonable explanation as to why either the TPOC report or the ORM assumption report was untimely.

Possible defenses include:

The claimant refused to provide their Social Security number (safe harbor applies)
Delayed acceptance of a claim due to litigation or investigation
Administrative errors with documented corrective measures
Technical issues with CMS submission systems

If CMS accepts the explanation, there will be no further action.

WC Reporting Penalties

Formal Notice

If CMS does not accept the explanation or there is no response to their informal notice, a formal notice, called a Notice of Proposed Determination to Impose a Civil Money Penalty, will be mailed to the Authorized Representative and copied to the Account Manager for the RRE.

Appeals Process

The appeals process provides multiple levels of review:

Level 1 – Administrative Law Judge (ALJ): The RRE has 60 days from receipt of the Proposed Determination to appeal to an ALJ.

Level 2 – Departmental Appeals Board: If the ALJ’s decision is unfavorable, the RRE has 30 days to file an appeal with the Departmental Appeals Board Appellate Division.

Level 3 – Federal Court: If the Departmental Appeals Board appeal results in an unfavorable decision, the RRE has 60 days to petition for judicial review in federal court.

Payment

Once the appeals process has concluded, or if no appeal is filed, a Notice of Final Determination will be sent to the RRE. The RRE has 60 days from receipt to make payment electronically through pay.gov.

Best Practices and Final Thoughts

The timeliness and accuracy of Section 111 reporting will mitigate and, ideally, eliminate any possibility of a penalty. To protect your organization:

Proactive measures:

Implement robust processes to capture Medicare beneficiary information at first contact
Establish clear procedures for the three-attempt safe harbor requirement with documentation templates
Maintain detailed records of all attempts to obtain beneficiary information
Review and update your CMS Profile Report contact information immediately
Develop internal timelines that build in buffer time before the 365-day reporting deadline

If you receive a penalty notice:

Respond immediately within the 30-day window
Coordinate with your Section 111 reporting agent, if applicable, to identify all possible defenses
Gather all documentation supporting your explanation

Please contact Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com with any questions.

CMS to Host Webinar on CMPs on January 15

December 10, 2025

The Centers for Medicare and Medicaid Services (CMS) will host a webinar regarding Civil Money Penalties for NGHP Responsible Reporting Entities (RREs) on Thursday, January 15, 2026, at 2:00 p.m. ET. Per CMS:

The presentation by CMS will include reminders about the Final Rule and auditing process, anticipated correspondence, and a question-and-answer session.

Note, this is a different CMS webinar topic than the October 1, 2025, session on WCMSA reporting that was scheduled and canceled due to the government shutdown.

There is no pre-registration for the webinar. Full details, including instructions on submitting questions before the webinar, can be found here and in the “What’s New” section of the CMS website.

WCMSA Reporting and MSP Compliance for 2025: Premier Webinar

December 18, 2024

Topic: WCMSA Reporting & MSP Compliance for 2025
Date: Thursday, January 16
Time: 2 PM ET

Are you prepared for the upcoming changes in workers’ compensation settlements? Starting April 4, 2025, all settlements involving Medicare beneficiaries will require a WCMSA amount to be reported—even if it’s $0—through Section 111 reporting process.

Join Dan Anders, Tower’s Chief Compliance Officer, and Jesse Shade, Chief Technology Officer, for an engaging and insightful webinar designed to help you navigate these significant changes.

In this one hour session, you’ll learn:

The key criteria and timeline for WCMSA reporting.
How to handle the technical implementation and testing process.
What these changes mean for claims professionals, attorneys, and settling parties.
Insights into MSAs and Conditional Payments in 2025.
Updates on Medicare Secondary Payer compliance under the new administration.

Bring your questions! A live Q&A session will follow the presentation, and you can submit questions during registration.

Don’t Wait—Get a Head Start on 2025!

Click below to reserve your spot and get the insights you need to stay ahead.

[Register Now]

Get ready, get informed, and stay compliant—see you on January 16!

Navigating Medicare Secondary Payer Compliance in Denied Workers’ Comp Claims

November 13, 2024

compass representing navigating MSP compliance

We’re excited to share that our Chief Compliance Officer, Dan Anders, is featured in WorkCompWire in an insightful article titled “Handling Medicare Secondary Payer Compliance in Denied Workers’ Compensation Claims.”

In this article, Dan explores:

The complexities of managing Medicare Secondary Payer (MSP) compliance when a workers’ compensation claim is denied.
Best practices to ensure compliance, minimize risks, and keep claim processes moving smoothly.

This is a must-read for anyone involved in claims management, compliance, or risk mitigation.

Read the full article on WorkCompWire: Handling Medicare Secondary Payer Compliance in Denied WC Claims.

At Tower MSA Partners, we’re committed to sharing valuable insights that help our clients navigate the intricacies of MSP compliance. Dan’s expertise provides practical advice on handling denied claims while remaining compliant with Medicare guidelines, and we’re thrilled to bring this knowledge to the broader industry.

For more insights and resources on MSA compliance, check out our blog regularly and follow us on LinkedIn.

October CMS Updates: Section 111 Reporting User Guide and Civil Money Penalties Webinar Highlights

October 31, 2024

Section 111 Reporting User Guide and Civil Money Penalties Webinar Highlights

Stay up-to-date with the latest CMS developments! This month, we’re covering the release of the NGHP Section 111 Reporting User Guide Version 7.7, the annual update to the ICD exclusion list, and key insights from the CMS Section 111 Civil Money Penalties webinar.

NGHP User Guide Version 7.7 Released

On October 7, 2024, CMS published Version 7.7 of the NGHP (Non-Group Health Plan) Section 111 Reporting User Guide. Here are notable updates:

Reporting of Wrongful Death Claims

In Chapter III; Policy Guidance, Section 6.5.1.4, CMS provided the following clarification:

“Note: Settlements, judgments, awards, or other payments obtained entirely under the wrongful death theory of liability, which do not claim and release medicals, or have the effect of releasing medicals, are not required to be reported because Medicare would have no recovery claim against such a payment.”

This statement is consistent with CMS’s previous guidance that Total Payment Obligation to Claimant (TPOC) amounts are reported only when medicals are claimed and/or released, or the settlement has the effect of releasing medicals.

Compliance Flags are now Warning Flags

In Chapter IV: Technical Information, CMS has renamed “Compliance Flags” in Section 7.4 to “Warning Flags.” Additionally, a new “04” warning flag has been introduced. This flag applies to claim response files with open Ongoing Responsibility for Medicals (ORM) records when the later date of either the CMS Date of Incident or the Part A Add Date is more than 135 calendar days after the Start Date of the Responsible Reporting Entity’s (RRE’s) submission period.

Understanding Warning Flags and Penalties

It’s important to note that warning flags do not necessarily equate to a potential civil monetary penalty for late Section 111 reporting. Here’s the key difference:

Warning Flags: Triggered if ORM or TPOC is reported more than 135 days after it should have been reported, as defined in the user guide.
Penalties: Potential penalties don’t come into play until 365 days have passed since the date the information should have been reported.

Why the different timeframes? We assume it is to encourage RREs to report promptly, ensuring CMS has the necessary information to coordinate benefits properly. Warning flags act as a reminder to the RRE that repeated reporting delays could lead to more significant issues, including potential penalties.

Updated ICD Code Excluded List

CMS published its annual update of valid and excluded liability and no-fault ICD-9 and ICD-10 codes for Section 111 reporting purposes. The list can be found here.

CMS Webinar Highlights: Section 111 Civil Money Penalties

On October 17, 2024, CMS hosted a webinar on Section 111 Civil Money Penalties. The webinar slides can be found here. Key takeaways:

Civil Money Penalty Correspondence: Notices will be mailed to the RRE’s Authorized Representative and the Account Manager. Reporting agents, such as Tower MSA Partners, will not receive a copy of the notice. Therefore, it is important for the RRE to ensure address information is up-to-date.

Compliance Clock Started: The compliance clock began ticking on October 11, 2024. Eligible MSP occurrences occurring on or after this date must be reported within 365 days.

Obtaining Beneficiary Information: When trying to gather beneficiary details, such as a Social Security Number, the RRE must reach out to both the beneficiary and, if applicable, their attorney. Contacting only the attorney isn’t sufficient. Additionally, you must make at least three attempts to obtain the information, with at least two attempts made via mail or email.

If you have any questions about these updates, please contact Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com.

CMS Sets October 17 for Webinar on Section 111 Reporting Penalties

October 9, 2024

Upcoming CMS Webinar on Section 111 Reporting Penalties

The Centers for Medicare and Medicaid Services (CMS) has scheduled an important webinar on October 17, 2024, at 1:00 PM ET, specifically covering Section 111 reporting Civil Money Penalties (CMPs) and their implications for all relevant stakeholders involved in compliance and reporting.

Webinar Format and Focus From CMS

CMS will be hosting a comprehensive webinar regarding Certain Civil Money Penalties for NGHP Responsible Reporting Entities (RREs). This informative session aims to clarify the implications of these penalties and ensure that all RREs are well-informed. The format will include opening remarks from CMS officials, followed by a detailed presentation that will cover essential topics. Attendees can expect reminders about the Final Rule, insights into the auditing process, and critical dates that RREs need to remember. After the presentation, there will be a dedicated question-and-answer session, allowing participants to seek clarification and address specific concerns related to the Civil Money Penalties. This interactive component is designed to enhance understanding and foster engagement among all attendees.

RREs who would like to submit questions in advance of the webinar are encouraged to do so using the dedicated resource mailbox at Sec111CMP@cms.hhs.gov.

There is no pre-registration for the webinar. Full details can be found here.

Previous Webinar Insights

The upcoming webinar focuses on Section 111 penalties, while a previous webinar covered Section 111 reporting best practices and upcoming changes. A copy of the slides and notes of the prior session are here.

CMS recently added a new page to its website, which provides NGHP Civil Money Penalties information, including a flow chart. CMPs are applicable starting October 11, 2024, and audits begin in January 2026. We encourage a review of CMS’ website and articles Tower has published on the topic, including Section 111 Reporting for WCMSAs & Avoiding Civil Penalties.

Tower MSA Partners’ Chief Compliance Officer Dan Anders Featured on Ametros Podcast “It’s Settled”

September 25, 2024

Dan Anders, Chief Compliance Officer at Tower MSA Partners, was recently featured on Ametros’ podcast, “It’s Settled.

We are excited to share that Dan Anders, Chief Compliance Officer at Tower MSA Partners, was recently featured on Ametros’ podcast, “It’s Settled.” In this engaging episode, Dan sat down with Andrea Mills, Ametros’ Chief Client Officer, and John Kane, Senior Vice President of Strategy, to dive deep into the latest news and developments surrounding Medicare Set-Asides (MSAs). This discussion covered essential topics that impact the workers’ compensation and liability settlement space, including upcoming changes to Section 111 reporting, best practices for preparing MSAs, and the value of professional administration.

Upcoming Section 111 Reporting Changes

One of the key topics covered was the upcoming changes to Section 111 reporting and their implications for insurers and self-insured entities. Dan provided insightful commentary on what these changes mean and how they will affect the reporting process. With new compliance requirements on the horizon, now is the time for stakeholders to review their reporting strategies and ensure they are prepared for these regulatory shifts.

When to Prepare an MSA

Another critical topic discussed was when to prepare an MSA. Dan highlighted the importance of evaluating the need for an MSA early in the settlement process to avoid costly delays. He also provided insights into how Tower MSA Partners helps clients navigate complex cases by offering expert guidance on when and how to prepare MSAs effectively.

The Value of Professional Administration

The conversation also touched on the value of professional administration for MSAs, emphasizing how Ametros helps individuals manage their settlement funds to ensure compliance with Medicare’s requirements. Dan, Andrea, and John discussed how professional administration not only ensures the longevity of settlement funds but also helps alleviate the administrative burden on injured individuals.

Tips for Preparing an MSA

During the episode, Dan shared several tips and tricks for preparing an MSA, helping listeners understand the importance of accuracy and thoroughness when it comes to documentation. He also explained how Tower MSA Partners’ streamlined approach helps clients minimize risks and expedite settlements.

Upcoming Webinars and Conferences

As the discussion wrapped up, the group previewed upcoming educational opportunities, including a webinar, A Claims Professional’s Guide to Successful Settlements with MSAs, hosted by Tower MSA Partners on October 2^nd. Dan encouraged attendees to sign up for this and other webinars to stay informed on compliance topics and best practices in the MSA industry.

Listen Now

You can catch this insightful episode of “It’s Settled” featuring Dan Anders by clicking here.

Stay tuned for more updates from Tower MSA Partners as we continue to provide our clients with the latest compliance and settlement strategies. Be sure to sign up for our upcoming October 2nd webinar to stay informed on these important issues.

CMS Sets September 12 for Webinar on Section 111 Reporting

August 28, 2024

Don’t Miss the CMS Webinar on Section 111 Reporting

The Centers for Medicare and Medicaid Services has scheduled a September 12, 2024 webinar on Section 111 reporting. Per the announcement:

The format will be opening remarks by CMS, a presentation that will include NGHP reporting best practices and reminders, followed by a question and answer session. For questions regarding Section 111 reporting, prior to the webinar, please utilize the Section 111 Resource Mailbox PL110-173SEC111-comments@cms.hhs.gov.

There is no pre-registration for the webinar. Full details can be found here.

While CMS does not indicate the webinar is specific to Section 111 Civil Money Penalties, given that CMPs become applicable as of October 11, 2024, this presents an opportunity to have any questions addressed before that date. Questions around the April 4, 2025 implementation of Section 111 Reporting of WCMSAs would also be encouraged.