The Centers for Medicare and Medicaid Services (CMS) issued final rules imposing civil money penalties on Medicare Secondary Payer (MSP) reporting violations. The final rules were effective December 11, 2023, but penalties are not imposed until October 10, 2024.
The Medicare Secondary Payer rules are applicable to group health plans provided by employers with at least 20 employees, including those in both the private and public sectors. These provisions help establish whether the employer-sponsored health plan or Medicare should serve as the primary payer for healthcare expenses of individuals who are eligible for Medicare.
Group health plans covered under MSP include not only traditional employee health plans but also dental, vision, and health reimbursement arrangements (HRAs) with annual benefits exceeding $5,000. MSP mandates that responsible reporting entities submit information to the Centers for Medicare & Medicaid Services, identifying Medicare beneficiaries who are covered by these group health plans.
The penalties for not complying with the reporting requirements are as follows:
The maximum penalty for noncompliance for any one individual is $365,000, adjusted for inflation.
Plans should plan to comply with the reporting requirements immediately.
Benefit Allocation Systems (BAS) provides best-in-class, online solutions for: Employee Benefits Enrollment; COBRA; Flexible Spending Accounts (FSAs); Health Reimbursement Accounts (HRAs); Leave of Absence Premium Billing (LOA); Affordable Care Act Record Keeping, Compliance & IRS Reporting (ACA); Group Insurance Premium Billing; Property & Casualty Premium Billing; and Payroll Integration.
MyEnroll360 can Integrate with any insurance carrier for enrollment eligibility management (e.g., Blue Cross, Blue Shield, Aetna, United Health Care, Kaiser, CIGNA and many others), and integrate with any payroll system for enrollment deduction management (e.g., Workday, ADP, Paylocity, PayCor, UKG, and many others).