10/1/2010 was MMSEA TPOC Day!

Posted date in Jason D. Lazarus, J.D., LL.M. Medicare, Medicare Secondary Payer Act, MMSEA, MSP Compliance

Section 111 of the Medicare, Medicaid & SCHIP Extension act is a law that will be implemented on 1/1/2011.  It requires insurers and self insured to report settlements with Medicare beneficiaries.  According to CMS, the “Total Payment Obligation to the Claimant (TPOC) refers to the dollar amount of a settlement, judgment, award, or other payment.”  “A TPOC generally reflects a “one-time” or “lump sum” payment of a settlement, judgment, award, or other payment intended to resolve/partially resolve a claim. It is the dollar amount of the total payment obligation to or on behalf of the injured party in connection with the settlement, judgment, award or other payment.”  TPOC’s must be reported back to 10/1/2010 as of the January 1, 2011 implementation date for reporting.  In the CMS user guide for Section 111, it states “[r]ecords with claim information are to be transmitted for claims that are addressed/resolved (or partially addressed/resolved) through a TPOC settlement, judgment, award or other payment on or after October 1, 2010 that meet the reporting thresholds.”  Therefore, 10/1/2010 was “TPOC day”.