ACE is aware of the Medicare, Medicaid & SCHIP Extension Act of 2007 which mandates additional reporting requirements for insurers. There are a number of questions regarding the introduction of these reporting requirements, including the question of who should be designated as a Responsible Reporting Entity (RRE).
The guidance from the Centers for Medicare & Medicaid Services (CMS) stipulates that the RRE is the entity funding the escrow for medical payments made to the Medicare beneficiary. ACE is adhering to this current CMS directive as it applies to all program types.
We have been involved in many conversations with our clients and brokers regarding ACE’s position as to who should be designated as the RRE for ESIS-administered Liability claims on ACE policies of insurance. While we believe there is merit to the position that our insured could be properly designated as the RRE for claims against deductible liability policies, we recognize the information received from CMS can be interpreted in several ways. To simplify this situation and to better assist our clients, ACE will register as the RRE for all liability claims managed by ESIS and attached to deductible policies issued by ACE.
Based on ACE’s interpretation of the current CMS documents, it’s our understanding the RRE should be designated as follows under these policy types:
| Guaranteed Cost |
The Insured has a policy without a deductible endorsement or a self insured retention (SIR). |
ACE |
ACE |
ACE |
| Deductible - AL/GL/PL |
The Insured has an AL, GL or PL policy with a deductible endorsement. |
ACE/Insured |
ESIS |
ACE |
| Deductible - AL/GL/PL |
The Insured has an AL, GL or PL policy with a deductible endorsement. |
Insured |
TPA other than ACE or ESIS; including Self Administration |
Insured |
| Deductible - AL/GL/PL |
The Insured has an AL, GL or PL policy with a deductible endorsement. |
ACE |
TPA other than ACE or ESIS; including Self Administration |
ACE |
| Deductible - WC |
The Insured has a WC policy with a deductible endorsement. |
ACE |
ACE/ESIS |
ACE |
| Deductible - WC |
The Insured has a WC policy with a deductible endorsement. |
Insured |
TPA other than ACE or ESIS; including Self Administration |
Insured |
| Deductible - WC |
The Insured has a WC policy with a deductible endorsement. |
ACE |
TPA other than ACE or ESIS; including Self Administration |
ACE |
| SIR -AL/GL/PL |
The Insured has an AL, GL or PL excess policy - the policy includes a Self Insured Retention (SIR) |
Insured |
All - claims within the SIR |
Insured |
| SIR - WC |
The Insured has an excess WC policy - the policy includes a Self Insured Retention (SIR) |
Insured |
All |
Insured |
The data for claims under policy types where ACE is designated as the RRE will be included in our submissions to CMS and all obligations and responsibilities associated with the RRE designation will be assumed by ACE. ACE insureds do not need to register as the RRE for the reporting of these claims.
Some ACE insureds have already registered as an RRE with CMS. If the registration was completed solely for the purpose of reporting claims on ACE policy types where ACE is designated as the RRE above, the insured is no longer required to be registered as an RRE. CMS has established a deregistration process and, if the deregistration process is not completed, CMS will expect to receive claims data from the insured. If PMSI was designated as the Account Manager when registering, they can assist with deregistration as well as answering questions that might arise. PMSI Settlement Solutions’ Client Service Specialists contact information is phone: 888 850-4161, hours: Monday – Friday, 8 a.m. – 8 p.m., e-mail: justregister@pmsisettlement.com.
Many of our accounts have programs that have been highly customized and may not neatly fit into one of the above categories. We are available to discuss any unusual programs with you or any of your colleagues.
Guidance from CMS may continue to evolve. If there are new requirements, the RRE roles outlined in the above table may also change. Please check this page periodically for updates. In the interim, if you have any questions regarding ACE’s position as it relates to the RRE issue, please contact Rick Raup at 302 476-7835 or via e-mail at rick.raup@acegroup.com.