The Centers for Medicare and Medicaid Services (CMS) made two welcome announcements today that impact the Medicare Secondary Payer compliance community. Beginning on October 7, 2019, CMS will offer new access to Open Debt Reports through the CMS web portal designated for disputing and resolving Medicare conditional payments claims. An Open Debt Report will list all known, open conditional payments claims that pertain to a particular insurer or self-insured. Currently, CMS only offered access to individual claims after an insurer or self-insured (or its representative) requested access to each claim. This new feature will allow the same entities to see if there are any claims CMS has open that the insurer or self-insured may not have known otherwise. This will be a valuable tool to help mitigate against liability for reimbursement of conditional payments, as well as to prevent or mitigate offsets that the U.S. Treasury might collect on the unknown claims before the insurer or self-insured plan had a chance to pursue a dispute.
The Medicare Secondary Payer (MSP) statute (42 USC §1395y, et seq.) states that Medicare is secondary to other forms of insurance, including “Non-Group Health Plans” (NGHP), which include workers’ compensation, liability, and no-fault insurance plans or self-insured plans. When Medicare conditionally pays medical bills it believes are the responsibility of an NGHP, the statute requires CMS to seek reimbursement of its payments. CMS will open a claim file and send notice to the NGHP, but often this notice does not reach the intended entity. If the NGHP does not respond within a certain time, CMS will refer the case to the Treasury to collect the amount claimed. As a result of the defective original notice, many cases have been referred to the Treasury for collection without the NGHP finding out until after money was already collected, and this has led to delays in prevailing on legitimate disputes to liability for the reimbursement amounts. Up until now, it was more difficult for NGHPs to be proactive and discover open conditional payments cases. This new program is a positive development for all stakeholders in the conditional payments process.
CMS will also host two webinars that address upcoming enhancements to CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) which will allow Medicare beneficiaries or their representatives to submit annual attestations electronically. The first webinar is directed to Medicare beneficiaries and their representatives and will be held on October 30, 2019 at 1:00 pm ET. The conference dial in number is 800-369-2170, Passcode 3307343. The second webinar, directed to Professional Administrators will be held on November 6, 2019 at 1:00 pm ET. The conference dial in number is 800-369-2170, Passcode 3307343.
We at Nyhan Bambrick Kinzie & Lowry stand ready to assist with any conditional payment issues, as well as all other aspects of MSP compliance and WCMSA administration. Please contact a member of our MSP team with any questions you may have.