Revised Medicare Secondary Payer Implementation Time Line for TPOC Liability Insurance Payments

November 16, 2010

The Centers for Medicare and Medicaid Services (CMS) has delayed the start of required reporting of one-time payments to Medicare beneficiaries by one year. The new time line applies only to liability Total Payment Obligations to Claimants (TPOC) claims, which are one-time payments that do not involve Ongoing Responsibility for Medicals (ORM). The time line does not change the reporting deadline for workers’ compensation claims, no-fault claims or claims with ORM.

Certain companies with self-insured retentions are considered Responsible Reporting Entities (RREs), and are required to report to CMS about settlements or awards paid to Medicare beneficiaries to cover medical costs from liability, no-fault and workers’ compensation claims. Liability TPOCs must now be reported if the TPOC date – the date the payment obligation is established – is on or after Oct. 1, 2011, rather than Oct. 1, 2010. Submission of initial claim reports for liability TPOCs will now begin during the first quarter of 2012, and not the first quarter of 2011. This is not the first time that CMS has pushed a reporting deadline back, and it is unclear what changes, if any, can be expected with regard to future reporting of liability TPOCs, although additional extensions are unlikely. We will continue to monitor developments.