Regulatory Compliance

Regulatory Liability Products and Services

Governmental regulations are constantly expanding and imposing compliance mandates that create growing risks to the affected entities. Those risks are unique and typically not well served by the mainstream insurance industry. Compliance risk is increased by the complexities and technicalities that make full compliance difficult - and, in some cases, nearly impossible. In response to the needs of organizations at risk for the consequences of non-compliance, MGU Specialty Risk Services offers specialized products and customized services that address these unique risks.

MGU SRS focuses its products and services toward the needs of organizations in five key industries as well as those impacted by Medicare and healthcare regulations that impact all industries. Our focus industries include: Healthcare, Maritime and Transportation, Energy, Food Safety & Agriculture, and Material Sciences & Technology.

MGU SRS has developed a specialty in the service of clients' Medicare compliance needs. Medicare compliance mandates derive from the Medicare Medicaid SCHIP Extension Act of 2007 ("MMSEA") and Medicare Secondary Payer Act ("MSPA"). Many organizations are not aware of their compliance obligations or the impact of inadequate compliance. Our products and services for our Medicare compliance program are described below.

MMSEA Section 111 Reporting Services

Section 111 reporting presents challenges and frustration for entities not specializing in the arena.  It is generally not to be undertaken as a pure clerical function.  Some of the Primary Challenges associated with Section 111 Reporting are as follows:

  • The navigation of required ICD-10 coding of injuries and causes of injuries
  • Reporting the proper value of structured settlements
  • Tracking and Reporting of “Ongoing Responsibility for Medicals “ (ORM) claims
  • Coordination with Medicare Set Aside (MSA) agreements
  • Inadequate Management and clearance of Medicare feedback loops.

MGU SRS provides compliance services that encompass the responsibilities that are mandated by law. We focus on accuracy in our management of claims so that the primary challenges shown above are minimized. As a Responsible Reporting Entity (RRE), what can you expect from MGU SRS’s Section 111 Reporting Services?

Execution of Compliance Tasks

The Section 111 compliance mandates are complex and technical. MGU SRS performs the tasks necessary for you to comply with the regulatory mandates. What do we do? The following:

  • Provide technical direction and consultation on current compliance mandates.
  • We will extract data from your claim files on your behalf in order to prepare and complete reports for submission to CMS. Other options with regard to data extraction are available.
  • We review medical records in order to perform specific injury coding (ICD-10 Coding).
  • We track and report ORM claims.
  • We prepare all reports, submit them to you and/or your counsel for review if desired, and approval if needed before submission to CMS.
  • MGU SRS can manage all feedback loops on your behalf from CMS through clearance.
  • MGU SRS coordinates Section 111 claims with MSA agreements.
  • Accurate ICD-10 Coding: Accurate coding of the injured party’s injury is the most critical aspect of Section 111 reporting. If inaccurate injury coding is submitted to CMS, then liability may ensue. (See our fact sheet on Medicare Reporting Liability Insurance)
  • Communication: We keep you apprised of the status of your Section 111 claims so that you maintain a level of understanding of the mandates and compliance actions.
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Medicare Reporting and Secondary Payer Liability Insurance

MGU Specialty Risk Services participated in the development of a new and robust Medicare Reporting and Secondary Payer Act Liability Insurance Policy underwritten by a major North American insurance company. The policy is designed specifically to insure the risks associated with MMSEA and MSP. The policy is available through select brokers and agents.

For additional information on the Medicare Reporting and Secondary Liability Insurance Policy, please send us a request through our “Contact Us” page.

Variance Analysis

What is MGU SRS’s Variance Analysis of Medicare Compliance?

It is a professional analysis of a Responsible Reporting Entity’s (RRE’s) internal operating practices related to Medicare reporting mandates. The studies are intended to determine the variance of current procedures from optimal Medicare compliance procedures. The analysis includes compliance with the mandates set forth in Medicare Medicaid SCHIP Extension Act of 2007 (MMSEA) and Medicare Secondary Payer Act.

What are the specifics of the analysis?

The analysis includes a review of the RRE’s Medicare compliance practices including:

  • Accounting Practices with respect to Medicare such as reimbursement requests,
  • Actuarial calculation of expected financial liabilities based upon your current compliance protocols and actual practice,
  • Documentation that supports compliance activities,
  • Information Technology support including audit of software coding,
  • Risk Management including risk reduction techniques in advance of loss, and
  • Claims Management including the claims resolution process, releases, and administrative procedures. Our analysis also examines the reporting.

What are the expected benefits of the analysis?

You will receive a study of your current conditions that may lead to governmental claims against you for failure to comply with regulatory mandates. You will receive a study that details our assessment of your Medicare compliance protocols and practices. Our findings will provide you with the necessary information to reduce the likelihood of civil fines, penalties, as well as civil liability claims that can include demands for double damages. The variance analysis will answer such questions as:

  • How does the reporting process impact the RRE’s potential liability in Section 111.
  • Are all required events currently identified and reported to CMS?
  • Does the RRE’s claims resolution process minimize or increase potential Section 111 liability?
  • Does the RRE’s current practice increase the likelihood of an audit by a Recovery Audit Contractor?

MGU SRS will answer these and other questions as well as offer detailed recommendations for reducing the risk of Medicare compliance liability.

Specialty Insurance Products

Medicare Liability

MGU Specialty Risk Services, working with select insurance agents, brokers, and major insurers and reinsurers, participated in the research and development of specialized insurance policies focused on protecting organizations identified as Responsible Reporting Entities (RREs) under the Medicare laws. These policies protect against many of the risks associated with Medicare compliance reporting for which, in general, no other coverage exists.

For more information about the specialized insurance policies now offered through a network of select agents and brokers, review the product brochure for “Medicare Reporting and Secondary Payer Act Liability Insurance” (MRSPAL) underwritten by Ironshore Specialty Insurance Company. Many new risks presented by Medicare compliance are not covered by most existing insurance programs. Therefore, the new and specialized policy was developed with the Medicare exposures as the focus.

The federal government has an enhanced ability to identify and pursue entities that are not in compliance. Those organizations face substantial fines ... up to $1000 per day … per event. More importantly, even those organizations that have fully complied but have submitted inaccurate data face costly outcomes … bodily injury claims by Medicare beneficiaries who have been denied medical care due to a Section 111 report that is inaccurate.

Are you required to report? CMS has produced a MMSEA Quick Guide to give you some idea of the needs and the complexity of reporting. There is no substitute for peace of mind and knowing that you are covered in this growing arena of litigation and collection efforts my Medicare and its contractors.

Medicare Compliance

MGU SRS offers solutions to those who must comply with the reporting mandates of Medicare. Our practice provides specialized products and services for organizations that are identified as Responsible Reporting Entities (“RREs”) under Section 111 of The Medicare Medicaid and SCHIP Extention Act of 2007 (“MMSEA”).

Reporting Services - Are you required to report?

We offer unparalleled expertise in the technical and complex reporting requirements in order to avoid unwanted outcomes from improper compliance and reporting.  Our reporting is based upon substantive reviews of claims in order to complete the Section 111 report.  We will not use reports generated through automated data uploads because their use can well increase the risk of bodily injury claims for inaccurate reporting.

We welcome inquiries regarding our reporting services and our technical skills in Medicare compliance.  Our mission is to make you compliant with the requirements of MMSEA.

For your information, CMS has produced a MMSEA Quick Guide to give you some idea of the needs and the complexity of reporting.

Medicare Compliance Insurance – Most companies are unaware that traditional insurance does not insure the risks associated with Medicare compliance.  MGU SRS has been instrumental in the development of an insurance program that iaddresses the unique and specific risks and exposures of non-compliance.  The associated risks include fines/penalties, bodily injury claims based upon negligent reporting, HIPAA violations, public relations events, Medicare billing errors, and others.  For information regarding Medicare compliance insurance, please contact us via our Contact US page.

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Continuing Education \ Continuing Legal Education

MGU Specialty Risk Services ("MGU SRS") is approved CE and CLE provider and offers courses in conjunction with our network of trusted advisors in the area of Regulatory Risks, Compliance Mandates, Compliance Audits and Compliance Insurance.