1) CMS Town Hall Teleconference Events
The CMS will host town hall teleconferences on the implementation of Medicare Secondary Payer mandatory reporting provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007. These teleconferences will take place from 1pm-3pm EST on the following dates:
Interested parties may participate by contacting 800-603-1774, pass code “Section 111”. Due to the large number of participants anticipated, please begin dialing approximately 20 minutes before the call state time.
2) CMS Memorandum issued December 5, 2011
Recently, Franco Signor LLC has seen an increase in letters from Part C and Part D providers requesting primary payer information from insurance companies. An example can be found here. We have linked this increase to CMS’ memorandum issued December 5, 2011, supporting the position that Part C and Part D plan providers have a right under federal law to reimbursement for services for which Medicare is not the primary payer. A copy of this memorandum can be found here. Interestingly, this memorandum directly contradicts recent state and federal case law on this issue. We recently blogged about this topic: See Franco Signor LLC New York Anti Subrogation Law Trumps Medicare Advantage Plans Recovery “Right” Under Medicare Secondary Payer Law, Published 12/05/11 and Franco Signor LLC Medicare Advantage Plans Have No Private MSP Cause of Action for Reimbursement, Published 02/03/2011. It is Franco Signor LLC’s position that the MSP statute does not give Plan C and Plan D providers, which are private insurance companies, the same rights as traditional Medicare. However, the recent CMS memorandum will surely be a catalyst for Part C and Part D providers who seek reimbursement as secondary payers. Franco Signor LLC has developed a solution to deal with what is expected to be an emerging and recurrent issue for insurers.
There is a new option available as for liability claims to self-calculate the final conditional payment amount prior to settlement. This option became available on February 21, 2012 for liability insurance (including self insurance) settlements, judgments, awards, or other payments.
In order to be eligible for this option, the liability insurance settlement, judgment, award, or other payment must meet the following criteria:
- It must be for a physical trauma based injury not related to ingestion, exposure, or medical implant
- It must be $25,000 or less
- It must be six months from the date of the incident to the date the beneficiary or his representative submits the self-calculated final conditional payment amount to Medicare
- The beneficiary must demonstrate through either:
- A written physician attestation, or
- A written certification provided by the beneficiary that:
- No medical treatment related to his case has occurred for at least 90 days prior to submitting the self-calculated final conditional payment amount to Medicare, and
- He expects no further care related to his case
- The beneficiary will have to give up the right to appeal the amount or existence of the debt; however, the beneficiary will keep the right to pursue a waiver of recovery.
Once the self-calculated conditional payment amount is submitted, the Medicare Secondary Payer Recovery Contractor (MSPRC) will make a determination of whether they agree or disagree with the self-calculated amount. If the MSPRC agrees, they will send a letter indicating that the amount is considered final as long as the claim is settled within 60 days of the date of the MSPRC letter and the settlement is $25,000 or less. This has the effect of eliminating exposure to potentially higher future conditional payment and final demand amounts. It is an option that can save both time and money for eligible claims. Franco Signor is ready to assist its clients with this new option.
For more information on the self-calculation option, please visit www.msprc.info