Sponsor’s Message on Workers’ Compensation
Data Scrubbing is a Must for MIR Compliance
Lessons Learned with Mandatory Insurer Reporting
Mandatory Insurer Reporting (MIR) compliance requires payers and their Reporting Agents to know and
understand the latest rules and thresholds to identify and
report only those claims which are necessary, and ensure
that the correct and required data is present in the right
format and fields. Failure to do so will result in non-compliance and possible fines.
It’s very possible that 2012 will be the time when CMS
imposes the $1,000 per day per claim fines for MIR.
Since this reporting is quarterly, just one claim with errors could mean a $90,000 minimum fine. Errors can
result from reporting unnecessary claims (non-Medicare
beneficiaries, for example), missing data in required
fields, incomplete or invalid data in required fields, and
data in the wrong fields.
CMS has noted that data scrubbing can significantly
lower the error rate of submissions. Proof of this is in
PMSI’s own book of business, which shows a 99.9%
submission acceptance rate by CMS. Following are a
few key points to consider with data scrubbing.
1 Not all claims are reportable. Gone are the days
of giving every claim to CMS and letting them “kick
back” the ones that aren’t necessary to report. Reporting unnecessary claims increases the error rate
and CMS can reject the entire report if it reaches
20%, leaving you in non-compliance.
2 Data must be accurate prior to submission. This
means verifying that every reportable claim has valid
and accurate data in all 250+ CMS-defined fields.
3 Data will most likely be in multiple source systems. Data will have to be compiled from these systems, validated and monitored—tasks legacy systems
just weren’t built to handle. This step is often skipped
by Reporting Agents because it takes a significant
amount of time and money to upgrade systems to
accommodate CMS’ specific and often changing requirements.
4 Automated systems with built-in CMS rules can
make data scrubbing a less tedious process. With
real-time reporting such as in PMSI’s MedicareCon-nectSM, payers can have a clear idea of their level of
MIR is really still in its infancy. As of yet, CMS has not
outlined how or when fines for non-compliance will be enforced. It is anticipated that this year, CMS will continue
to evaluate the efficiency and effectiveness of the MIR
process and continue to make modifications as necessary.
Continuing the conversation:
The video below features Pat Sullivan, PMSI’s President of Specialty Services, who discusses MIR further.
You can also access related materials in the links to
PMSI is pleased to announce its
partnership with Risk & Insurance as the exclusive Digital Edition sponsor. PMSI and Risk &
Insurance share a common goal
to deliver workers’ compensation
news that is relevant and timely
using smart technologies.
Throughout 2012, this Welcome
page will feature an editorially
focused article and short video on
a topic that discusses the dynamics of the industry. PMSI, one of
the largest and most experienced
companies in workers’ compensation, connects you with electronic
resources to keep you informed
and prepared—ultimately, making your job easier.
We look forward to sharing our
more than 35 years of workers’
compensation experience with
you in this forum and through social media. Additionally, PMSI has
a wealth of insights available
on our website, including our
ExpertInsights video library.
Watch The ExpertInsights Video Series: