Risk & Insurance - January/February 2012

INSIGHTS 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 compliance.

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 the right.

Thought Leadership

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.