Centers for Medicare & Medicaid Services (CMS) has determined that, given the time and resources necessary to accurately and thoroughly evaluate the accuracy of any submitted record, it would be possible to audit a total of 1,000 records per calendar year across all RRE submissions, divided evenly among each calendar quarter (250 individual beneficiary records per quarter). Credit: CMS
On October 11, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule on the imposition of civil monetary penalties for failure to comply with Section 111, mandatory insurer reporting requirements. The rule's focus and the sole reason for penalties will be untimely reporting. Even if a responsible reporting entity (RRE) reports untimely, it may only be subject to penalties if that claim is identified through a randomized quarterly audit process.
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