The Centers for Medicare and Medicaid Services (CMS) recently posted a fact sheet for attorneys and third party payers. The fact sheet provides basic information, such as when Medicare Secondary Payer laws are applicable, Medicare’s interest in settlement proceeds, and reporting potential MSP situations.
Monthly Archive for April, 2010
On March 9, 2010, Representative Patrick Murphy (D-PA) introduced H.R. 4796, the Medicare Secondary Payer Enhancement Act of 2010, into the U.S. House of Representatives. The bill proposes several changes to the Medicare Secondary Payer (MSP) Act.
Minimum Threshold
Any settlement, judgment, award, or any other payment with a total obligation of less than $5,000.00 would be exempt from the MSP Act.
Voluntary Calculation and Payment of Conditional Payment
At least 90 days prior to a reasonably expected settlement, judgment, award or any other payment, a claimant and applicable plan would be able to: (1) voluntarily submit to the Centers for Medicare and Medicaid Services (CMS) a conditional payment calculation; and (2) reimburse CMS for this amount. CMS would have 75 days from receipt of the reimbursement payment to contest the amount and to provide a final demand for the balance of the remaining amount owed.
Request for Final Demand for Reimbursement
Beginning 120 days prior to the reasonably expected settlement, judgment, award, or other payment, a claimant and applicable plan would be able to request a final demand payment for reimbursement from CMS. Within 60 days, CMS would be required to provide the final demand amount. After receiving CMS’s final demand, the claimant or applicable plan would have 60 days to reimburse CMS the final demand amount. If CMS does not provide a final demand within 60 days of receiving a request, the claimant, applicable plan, or an entity that receives payment from an applicable plan would not be liable for and would not be obligated to reimburse CMS for any item or service related to the request for final demand for reimbursement.
Appeal Process
The bill requires CMS to set up an appeal process. Claimants and Non-Group Health Plans would be able to appeal MSP determinations.
Section 111 Reporting Requirements
The proposed changes require CMS to implement a reporting process so that responsible reporting entities do not have to access or report social security numbers or health identification claim numbers. The statute of limitations for MSP recovery actions would be three years from receipt of the Section 111 report. The penalty provisions would be amended to provide the government with discretion to impose monetary penalties rather than requiring the government to impose such penalties. Finally, CMS would have to develop safe harbors for meeting the mandatory reporting requirements.