Medicare Secondary Payer

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The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule entitled “Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal.” From the outset of litigation, a plaintiff who is a Medicare beneficiary (or his or her attorney) must report a pending claim to CMS.  This allows Medicare to determine the amount of any conditional payments made to or on behalf of the beneficiary related to the claims at issue for which it would be entitled to seek reimbursement. To date, this process has presented certain timing and other logistical challenges. CMS’ publication of this final rule offers involved parties a streamlined mechanism by which they can access Medicare Secondary Payer (MSP) conditional payment amounts, and it also provides a detailed timeline by which certain information must be communicated to CMS.
Continue Reading CMS’ Web Portal: Final Rule 21 CFR § 411.39 Promises Quick and Efficient Conditional Payment Resolution for Those Able to Abide by Its Strict Guidelines

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that implements Medicare Secondary Payer (MSP) appeals provisions under the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act). Specifically, the rule addresses the right of appeal and a new multilevel appeal process for liability insurance (including self-insurance), no-fault insurance, and…

CMS has published an advance notice of proposed rulemaking soliciting comments on the imposition of civil money penalties (CMPs) for failure to comply with Medicare Secondary Payer (MSP) reporting requirements for certain group health and non-group health plans arrangements. Importantly, the SMART Act revised the language addressing CMPs of $1000 per day for responsible reporting…

On September 20, 2012, the House Energy and Commerce Committee approved by voice vote H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act. The legislation would make a series of procedural changes to MSP rules intended to “speed up the process of returning money to the Medicare Trust Fund while reducing costly legal barriers…

CMS has released its 2011 Ombudsman Report to Congress, which describes the activities of the Office of the Medicare Ombudsman (OMO) and sets forth the OMO’s recommendations for improving beneficiaries’ experiences with Medicare. Specific recommendations to CMS cover three topics: (1) recovery of conditional payments from beneficiaries by the Medicare Secondary Payer Recovery Contractor;…

On June 15, 2012, CMS published an advance notice of proposed rulemaking (ANPRM) to solicit comments on how to resolve certain Medicare Secondary Payer (MSP) obligations related to “future medicals” – that is, medical care furnished after a settlement (including judgment, award, or other payments) involving automobile and liability insurance, no-fault insurance, and workers’ compensation…

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CMS recently issued updated information regarding the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), Section 111 "Mandatory Insurer Reporting" requirements. The recent updates address: (1) a revised implementation timeline for certain liability insurance (including self-insurance) total payment obligation to claimant settlements, (2) revised guidance on claims involving exposure, ingestion, and implantation…

CMS has issued a series of guidance documents on the Medicare Secondary Payer (MSP) mandatory reporting provisions in section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). The new guidance documents address: risk management write-offs by providers, physicians, suppliers, and non-provider/supplier entities; reporting health reimbursement arrangements; what entities are MMSEA Section…

Medicare is the “secondary” payer of health benefits for Medicare beneficiaries when another entity is the “primary” payer. Under new MSP enforcement rules, all entities that are considered primary payers and meet the definition of a responsible reporting entity (RRE) must register with CMS and comply with certain reporting requirements. Such RREs include (1) group…