Every industry has inherent risks, and proactive management is crucial for avoiding the consequences. Those consequences often involve monetary loss, but unmanaged risks can also hurt your organization in areas like agility, efficiency and reputation. Manual risk management usually involves outdated systems like spreadsheets and email attachments, but a risk management platform can streamline the process, and enable you to mitigate risk.

With the ability to capture incident data, identify root-cause, take corrective action and track progress, a digital system can help you revolutionize your approach to risk management and reap the many benefits that come with it.

What Is a Risk Management Information System?

A risk management information system, or RMIS (pronounced “RIM-iss”), organizes and stores a wide range of risk management data — such as claims records, property values and loss control measures — and turns it into actionable resources. A RMIS allows decision-makers to act on all available data and access relevant insights. It can also serve as an incident reporting tool and may have industry-specific features.

Some functions you might find in a RMIS include:

  • Cloud-based access for field reporting from any device, in any location.
  • Dashboards to visualize risk factors.
  • Reporting features, such as loss run generation.
  • Business rule modules to automate common actions and workflows.
  • Claims and policy management.
  • Property and asset management.
  • Activity logs to track adjuster notes and actions.
  • Notification of open action items, such as court dates, appointments and filing deadlines.
  • Medicare Section 111 compliance.
  • Financial tracking for reserves, payments, and collections.

The RMIS provides a centralized space for these resources, so users can access the information they need from one convenient program. Centralizing your data can provide more security, too, since users can store information directly in a protected system instead of fragmenting it across different devices and platforms.

What Are Risk Management Information Systems Used For?

Many different businesses use RMISs to avoid and keep track of incidents, claims and risks. Some circumstances that typically call for a dedicated RMIS include:

  • High levels of risk: Industries like construction, manufacturing, utility and transportation naturally involve considerable risk with issues like potential injuries and damage to assets. A RMIS helps organizations respond to incidents, avoid them and factor them into business decisions to facilitate prevention.
  • Regulatory compliance needs: Risks can also come in the form of violated regulations, so businesses like healthcare and food and beverage companies often use a RMIS to oversee them. They might use it to watch for potential violations and assess their impacts.
  • Complex insurance coverage: Some businesses have complex, layered insurance policies and work with multiple carriers. A RMIS can help users navigate the demands and risks associated with each one.
  • International concerns: Operating across borders can come with challenging policies and multiple languages and currencies. With a RMIS, businesses can more easily accommodate the risks associated with international operations.
  • Large quantities of data: Large businesses or those with a large number of assets benefit from the visibility a RMIS offers. It can keep data in one place and let users access everything in an organized way, avoiding errors or time-consuming navigation demands.

The Benefits of a RMIS

While a RMIS offers the foundation for necessary tasks, a dedicated platform also helps businesses improve their risk management approach overall. A RMIS can offer benefits such as:

1. Fewer Errors and Auditability

When you use scattered apps and manual processes, errors become inevitable. A typo here or an outdated document there can result in costly ramifications for an organization dealing with claims. It could also lead to significant time spent fixing problems, such as chasing down files or repairing a damaged reputation. With robust tools for organization and automated reporting, a RMIS is a powerful resource for reducing human error.

A RMIS can help mitigate human error through detailed audit logs, as well. In highly regulated industries, for instance, these logs might be required, and the RMIS creates them automatically.

2. Business Agility

Modern businesses must be able to pivot their strategies in response to evolving demands. From normal fluctuations to adopting new technologies, agile capabilities let organizations respond to threats and make changes without excessive risk.

Agility is often a primary factor in company growth, and a RMIS supports agile initiatives by providing a clear picture of the company’s risk and a flexible, scalable platform.

3. Centralized Data

The old-fashioned approach typically involves stashing data away in various places, like individual laptops, hard drives and different apps. Files can get lost or destroyed, and users might have to spend precious time collecting information from other people. With a RMIS, your data stays in one place, ideally accessible through the cloud.

All users involved in the claims process can access the information they need from anywhere and on any device. An employee can manage claims from their phone in the field or on a desktop computer in the office. Data centralization also enables robust and customizable dashboards and reports for fast insights into the most important areas of risk management.

Overall, a centralized approach can help improve data quality, collaboration and speed.

4. Efficiency

Unsurprisingly, all that ease of use and flexibility can help employees work much faster. They can eliminate the tedious work associated with manual processes and focus more on the tasks that demand their attention and skill.

Some of the features employees might use to save time with a RMIS include:

  • Automated reporting
  • Workflows and event triggers
  • Streamlined user interface
  • Email/document templates
  • Reminders
  • Search tools
  • At-a-glance dashboards

5. Cost Savings

With all of these benefits comes cost savings related to many different processes. For instance, greater efficiency can help save on labor costs and reduce employee frustration, while reduced errors can protect against violations or expensive fixes. Business agility can impact the trajectory of a company and allow for new possibilities that would not be possible if it was too difficult to make changes.

Get More From Your Risk Management With Cloud Claims

Now that you have seen RMIS explained, you can find the right tool for your business and approach risk management in a more effective way. Whether your main priority is speed, accuracy or something else, Cloud Claims can help. This cloud-based RMIS from APP Tech offers a host of features for reducing risk and working more efficiently, including:

  • Rich and flexible reporting
  • Thorough incident data capture
  • Automated notifications
  • Reminders and activity logs
  • Tag-based organization
  • A customizable dashboard
  • Global Search
  • Claim financials

Cloud Claims is an incident-based platform that is easy to deploy, scalable and tailored to the unique needs of your business. Our clients span diverse industries like transportation, insurance, third-party administration and construction. We push updates automatically and maintain top-tier security standards for all of our products.

Reach out today, and see for yourself why so many companies trust Cloud Claims and APP Tech for their risk management software.

If you make payments to Medicare beneficiaries, you are required to report them under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). MMSEA supports transparency between payers and Medicare to improve benefits administration, but reporting can be tricky business. You need to set up the right software, identify the right people and follow the right timelines.

To help you avoid violations and simplify MMSEA reporting, we put together this MMSEA Section 111 user guide.

What Is MMSEA Section 111?

MMSEA Section 111 created mandatory reporting requirements for organizations that make certain payments to Medicare beneficiaries with group health plans (GHP) or non-group health plans (NGHP), including liability insurance, no-fault insurance and workers’ compensation. A party subject to Section 111 requirements is called a responsible reporting entity (RRE). These include GHP and NGHP organizations that function as an insurer or self-insurer. RREs may also include plan administrators or fiduciaries for self-insured or self-administered plans. In some situations, third-party administrators (TPAs) or other agents are delegated by RREs to manage the Section 111 reporting process, but the ultimate responsibility for Section 111 reporting remains with the RRE itself.

A quick background of Medicare can help us explain MMSEA Section 111 further. Medicare was introduced back in 1965 as a primary source of payment and amended in 1980 to be a secondary source. With this update, called the Medicare Secondary Payer Statute (MSP), workers’ compensation and primary insurers became the primary payers. The statute limited Medicare’s responsibility for these benefits, but it requires significant data transparency to enforce. The MMSEA reporting requirements aim to support enforcement through amendments to MSP.

One notable, recent update to MMSEA comes from the Provide Accurate Information Directly (PAID) Act, which Congress passed in late 2020. It helped NGHP RREs better identify Medicare beneficiaries with improved data from the Centers for Medicare and Medicaid Services (CMS). It offers more details about enrollment, including participation in Medicare Advantage (Part C) or a Prescription Drug (Part D) plan, to ease reporting demands for RREs.

CMS introduced MMSEA Section 111 to help identify primary payers and support more accurate benefits payments. In other words, it helps CMS avoid paying for benefits that should be covered by primary insurance providers. It also authorizes CMS and RREs to exchange health insurance information electronically. While Section 111 reporting supports a necessary part of Medicare administration, it also adds some challenges for RREs, who must dedicate time and energy to accurate, timely reporting.

Penalties of Non-Compliance With Section 111 of MMSEA

Non-compliance with CMS MMSEA Section 111 can come with steep fines, including civil money penalties (CMPs) of up to $1,000 per claim per day. The statutory maximum penalty is up to $365,000 per beneficiary per year. CMS proposed limiting these penalties in February 2020 with a 3-year standardization time limit, but the final ruling timeline has been extended to Feb. 18, 2024. After the ruling is published, CMS can levy penalties, so RREs must ensure a dependable reporting process ahead of this deadline.

Who Has to Report Under MMSEA Section 111?

MMSEA Section 111 Reporting Requirements

RREs can be insurers or self-insurers. For self-insured or self-administered plans, the RRE is the entity which funds payment on the plan’s claims. While RREs can use agents or TPAs to help with reporting, the RRE remains responsible for the accuracy and on-time submission of the reports.

Each quarter, RREs must submit electronic data on liability, no-fault and workers’ compensation claims for Medicare beneficiaries. CMS will then confirm the injured party’s Medicare status and confirm acceptance of the claims.

How Do I File a Section 111 MMSEA Report?

Filing an MMSEA report is technically challenging, and with such hefty fines, you will want to get it right. The reporting process for MMSEA Section 111 includes the following steps:

  1. Before you can submit anything, you will need to obtain an RRE identification number from CMS and establish a method of communicating with CMS’s platform, called an electronic data interchange (EDI). EDI provides a secure data exchange and standardized formatting, but it requires a specific type of platform that can be difficult for organizations to set up independently.
  2. You will also need to determine which people are Medicare beneficiaries according to CMS’s criteria. Age is insufficient on its own, so finding beneficiaries might be challenging. You need to submit key information about each claimant, such as social security numbers, names and dates of birth, to Medicare’s query tool to look for a match and get a corresponding Medicare ID to use with your claims.
  3. After identifying the Medicare beneficiaries within your claims, you must submit detailed reports quarterly, during a CMS-assigned submission window, and process responses from CMS to identify errors. Errors could render your claim unreported and affect compliance. Integrating your current claims system with the EDI process can be very helpful to give you visibility into the process, catch errors, and avoid data re-entry.

Throughout the process, you must stay up-to-date on any changing CMS requirements and protocols, such as the PAID Act, and maintain a thorough audit trail. This audit trail should reveal any interaction that someone has had with the claim and will be needed if CMS decides to investigate your organization.

What About the Direct Data Entry (DDE) Option?

Alternatively, you can use the Direct Data Entry (DDE) claim submission method offered by CMS. However, this option is open to RREs that plan to submit less than 500 claims per year and it should also be noted that each add, update and delete transaction counts toward this annual limit. DDE submitters are bound to all of the NGHP User Guide requirements. The DDE option is not intended for RREs with significant claim volume since only one claim report can be submitted at a time but is a useful, no-cost option if an RRE has only a handful of claims to report each year.

MMSEA Section 111 Reporting Software

Since many components are involved in MMSEA reporting, NGHP RREs often use a dedicated program to handle Section 111 reporting requirements. A software platform can greatly improve your ability to submit reports accurately and on time. It streamlines the process and helps you avoid the human error of manual processes. Some tasks that an MMSEA reporting platform can offer include:

  • Identifying Medicare beneficiaries
  • Validating submissions for errors prior to submission, avoiding rejections
  • Keeping an audit trail
  • Providing detailed reporting
  • Integrating with claims software to avoid manual data re-entry
  • Handling all the complexities of EDI

Despite the complex nature of mandatory insurer reporting (MIR), a software system should be user-friendly. Employees can spend less time navigating Section 111 requirements or creating opportunities for errors. Cloud-based MMSEA Section 111 reporting programs are particularly valuable, allowing you to access data from any device and location. They also let the provider update the system as needed, such as when CMS changes its requirements.

Streamline Your Section 111 Reporting With MIR Express™️

Government reporting does not leave room for error, so look for a platform you can depend on. MIR Express™️ is built for NGHP Medicare reporting and packed with features for reliable, efficient compliance. We have an acceptance rate of over 99.96% over millions of submitted claims, and we offer guaranteed on-time reporting during an RRE’s assigned reporting periods. With automated monthly and quarterly submissions, MIR Express™️ helps you streamline MMSEA Section 111 reporting and breathe easy.

The platform comes at a flat rate and is completely unbundled: you will not need to pay for additional managed services or contracts. MIR Express™️ is fully integrated with Cloud Claims, to deliver a complete end-to-end claims and Section 111 compliance solution! Let MIR Express take the stress and complexity out of Section 111 reporting requirements. Learn more about MIR Express or reach out to us today!