Section 111 Total Payment Obligation to Claimant Reporting and Bifurcated Settlements

8.18.2020 Blog

I recently wrote about Section 111 Total Payment Obligation to Claimant (TPOC) reporting in bifurcated settlements. Given the ambiguity in the NGHP User Guide, claims handlers have reported TPOC in indemnity only settlements that kept future medical rights open. When medical closed at a later date, the Section 111 Ongoing Responsibility for Medical (ORM) termination report was made. This has resulted in issues with conditional payment retrieval.

CMS directly addressed the timing of the Section 111 TPOC report in bifurcated settlements in its Section 111 Non-Group Health Plan reporting webinar on August 13, 2020. CMS representatives clearly advised that a TPOC report should only be made when the settlement releases or closes out any claim for future medical in the case. Given some of the follow up discussions regarding industry practices, it would be beneficial for claims handlers to review their TPOC reporting practices to bring them in line with CMS guidance. Our team is ready to assist with any questions that may arise from these timing issues.

The NBKL blog is provided for informational purposes; we are not giving legal advice or creating an attorney/client relationship by providing this information.  Before relying on any legal information of a general nature, you may consider consulting legal counsel as to your particular facts and applications of the law.