Medicare and Workers' Compensation: Essential Facts to Understand
Warning bell rang! Here's the skinny on letting Medicare know about your workers' comp deal:
- First things first, check if the injured joe is a Medicare recipient. If they're getting their medical coverage from Uncle Sam, you gotta report that workers' comp settlement!
- Gather all the deets on the settlement. That means details like defensive driving classes, worker's comp payments, and stuff like that. You'll need over 200 data points to get this done, including ICD codes, accidents, and the plaintiff's personal info.
- Report that sweet settlement cash to Medicare's pals at the Centers for Medicare & Medicaid Services (CMS) through the Section 111 mandatory insurer reporting process by April 4, 2025. The NGHP User Guide helps you figure it out.
- Starting April 4, 2025, you gotta report all settlements involving Medicare beneficiaries. No more thresholds or ifs, ands, or buts – report 'em all!
Why bother with reporting?
Remember, skipping the reporting can lead to some serious civil monetary penalties of up to $1,000 a day, per claim. So, don't be a fool – report that thing!
The Long and Short of It
Workers' comp is insurance for injuries and illnesses on the job for fed employees and other groups. Make sure you're schooled up on how it affects Medicare so you steer clear of medical expense issues. And, don't forget to keep Uncle Sam in the loop to dodge claim denials and reimbursement obligations.
Check out these resources:
For more on navigating the tricky waters of medical insurance, head on over to our Medicare hub.
- If an injured worker is a Medicare recipient, it's crucial to categorize their workers' comp settlement under 'healthsystems', as failure to report may result in penalties under 'science', such as civil monetary penalties of up to $1,000 per day, per claim.
- To effectively report workers' comp settlements to Medicare's Centers for Medicare & Medicaid Services (CMS), one needs to collect and submit over 200 data points, including 'nutrition' details like ICD codes, accidents, and personal information, as well as 'health-and-wellness' related expenses such as defensive driving classes and therapies-and-treatments.
- Starting April 4, 2025, all workers' comp settlements involving Medicare beneficiaries must be reported to CMS, regardless of the settlement amount, a requirement that falls under the Section 111 mandatory insurer reporting process.
- Delve further into understanding how workers' comp and Medicare intersect, as this knowledge is essential for avoiding 'healthsystems' complications like claim denials and reimbursement obligations in the realm of 'health-and-wellness'.
