Rising Launches MMSEA Section 111 Reporting Solution


January 11, 2023 – Chicago, IL – Rising Medical Solutions (Rising) today announced its product portfolio expansion to help payers comply with Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA). The company’s new Section 111 reporting solution decreases payer liability for excess recovery costs and fines, while mitigating potential litigation by beneficiaries for improperly reported claims.

Rising’s reporting service is part of a comprehensive suite of Medicare Secondary Payer (MSP) compliance and settlement solutions the company offers and is a natural extension of its existing managed care product portfolio. Section 111 reporting is used to ensure Medicare pays appropriately for Medicare beneficiaries’ covered treatment. Accurate and mandatory insurer reporting is essential to protect the financial interests of all parties when an injury has occurred – the injury claim payer, Medicare, and the beneficiary.

Many Section 111 reporting solutions use broad-based codes that can result in over reporting, whereby high-level diagnosis codes are submitted that include a body part(s) not relevant to the specific injury. This can create complications for beneficiaries if Medicare rejects payment due to misreporting. To alleviate this common problem, Rising uses precise injury diagnosis codes, leveraging its expertise in medical bill review and clinical coding to provide specific and accurate Section 111 reporting.

“Our goal is to make every part of the claims management process easier, including unburdening customers from numerous mandatory compliance, reporting, and system connectivity requirements,” said Rising CEO Jason Beans. “Through a single data integration with Rising’s technology platform, we uniquely provide Section 111 reporting based on our vast medical bill database and granular clinical coding logic, established compliance reporting services, and automated technologies that eliminate data integrity issues and manual processes.”

Rising’s Section 111 reporting can be purchased individually or bundled together with its other MSP and/or managed care services. The company’s full set of MSP solutions address medical costs and regulatory compliance throughout the settlement lifecycle and include:

  • Pre-Settlement Cost Mitigation
  • Medicare Status Checks
  • Social Security Benefit Determinations
  • MMSEA Section 111 Reporting
  • Medical Cost Projections
  • Medicare Set Aside Allocation & Submission Services
  • Conditional Payment Services
  • Post-Settlement Administration Services

For more information, visit Rising’s Section 111 Reporting webpage or contact info@risingms.com.

About Rising Medical Solutions
Rising Medical Solutions is a national managed care firm that provides medical cost containment and medical care management services to the workers’ compensation, auto, liability, and group health markets. Rising also directs and publishes the annual Workers’ Compensation Benchmarking Study, a national research program examining the complex forces impacting claims management in workers’ compensation today.