Clarification from CMS’ Recent Civil Money Penalties Webinar: All Workers’ Compensation TPOC and ORM Records are Delayed to July 2026
Following last week’s Centers for Medicare and Medicaid Services’ (CMS) webinar, which we blogged about here, some attendees were left questioning whether the delay they announced for the imposition of civil money penalties (CMP) on Workers’ Compensation claims applied solely to settlement/TPOC (total payment obligation to the claimant) records or to both ORM (ongoing responsibility for medicals) records and TPOCs.
CMS has clarified that all WC records (both TPOC and ORM) are delayed to July 2026. CMS also released a copy of the slides from last week’s webinar this week, which can be found here.
What does this mean in practice?
This means that CMS will not look to impose CMPS on WC records where the initial assumption of ORM and/or reported TPOC is dated prior to July 2025. For example, a WC claim settles on June 15, 2025, and is not reported until November 2026. Although this is reported more than 1 year after TPOC was to be reported, because it occurred before the July 2025 date, it is not subject to penalties. However, if a WC claim is settled in full on August 11, 2025, and is not reported until September 2026, this claim would be subject to potential penalties because it occurred after July 2025 and was reported more than 1 year after settlement.
CMS chose July 2025 as the date to start the one-year clock for penalties as it represents two full reporting periods from when the announcement was made regarding the WC Section 111 reporting updates. CMS continues to hold, pursuant to the CMP final rule, that RREs will not be subject to CMPs for major changes that are made to the program until at least two reporting periods (6 months) after the change is announced. This provides RREs with the necessary time to adjust their policies, procedures, and systems without fear of a CMP.
Sanderson Firm Takeaway
We welcome and appreciate this clarification from CMS. Our team of experts closely follows agency action with respect to all aspects of Medicare Secondary Payer (MSP) compliance. We believe that MSP compliance doesn’t have to slow settlements, it simply has to be done right. Contact us to learn more about our full-service MSP compliance service offerings: Medicare Set-Aside allocations, conditional payment/lien resolution, Section 111 Mandatory Insurer Reporting and audits, as well as legal consulting services.
