Government Shutdown Impacts Medicare Secondary Payer Compliance
Roy Franco
October 4, 2013

The stalemate in D.C. has now reached the front-line adjuster’s desk.  Non-essential employees for most Federal Agencies have been furloughed and this includes key personnel within the Centers for Medicare & Medicaid Services (CMS) and Social Security Services Administration (SSA)  who work on Medicare Secondary Payer compliance.  CMS contractors that work on Medicare Secondary Payer Compliance are not impacted and remain open which includes:  Coordination of Benefits Contractor (COBC); Medicare Secondary Payer Recovery Contractor (MSPRC); and Workers Compensation Review Contractor (WCRC).  These contractors will continue to process work, but only to the extent CMS involvement is not necessary.   Social Security verifications cannot be submitted or processed during this time.   Workers’ Compensation Medicare Set Asides can be submitted and reviewed by WCRC, but there will be no approvals during the shutdown, as CMS Regional Office personnel are responsible to issue final determination letters.

Notwithstanding, investigation and conditional payment resolution can still be performed through the COBC and MSPRC, including applicable websites such as the MSPRC portal.  However, post settlement compromises or reductions requiring CMS intervention under 42 C.F.R. §411.28 (recovery and compromise of claims) is off-line.
We continue to monitor this fluid situation and provide immediate updates as they occur.