TPOC Threshold for Section 111 Reporting Changes October 1, 2013

Beginning October 1, 2013 the mandatory reporting threshold for workers’ compensation and liability insurance (including self-insurance) is reduced to require reporting of TPOC amounts over $2,000. Reporting of TPOCs which meet the mandatory threshold is required during the RRE’s submission timeframe in the quarter beginning January 1, 2014.  RREs are also given the option to report any TPOCs greater than $300 up to $2,000 although reporting is not required.  Any TPOC reported with an amount equal to or less than $300 will be rejected.  The October 1, 2013 threshold change will likely have a greater impact on liability cases than it does on workers' compensation cases.

All mandatory TPOC reporting thresholds and the corresponding required reporting dates are shown in the table below.  Additional information can be found in Chapter III: Policy Guidance of the NGHP User Guide in the link below.

http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/NGHPUserGuideVer36Ch3Policy.pdf