Preparing for MIR Audits

Workers’ comp claims involving bodily injury by current Medicare beneficiaries are subject to the $1,000 per day civil monetary reporting penalty. To date no such penalty has been assessed, but that will change in the not too distant future. Insurance executives, risk managers, and in-house attorneys should take steps now to audit their Mandatory Insurer Reporting protocols to reveal weaknesses and deficiencies which can be remedied in advance of new penalty regulations, which are expected to be finalized no later than February 2023. MIR audits represent a best practice that all payers should adopt. Minimally, the audit should confirm that your company has registered as a Responsible Reporting Entity; submits timely reports to Medicare; does not send Medicare contradictory data; the reports submitted by your company do not exceed Medicare’s established error tolerance thresholds; your company makes good faith efforts to obtain reporting information which meets CMS standards from every Medicare beneficiary making a claim.