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Medicare Secondary Payer Act Alerts

Medicare Secondary Payer Act Alerts

CMS Implements a New Fixed Percentage Option for Settlements of $5000 or less in liability settlements
November 7, 2011, by Mary Re Knack

CMS will accept at flat 25% of any liability settlement of $5,000 or less as payment in full of the MSP reimbursement obligation if the following criteria are met:

  • The liability insurance (including self-insurance) settlement is for a physical trauma based injury, not ingestion, exposure, or medical implant, and
  • The total liability settlement, judgment, award, or other payment is $5000 or less, and
  • The beneficiary elects the option within the required time frame and Medicare has not issued a demand letter or other request for reimbursement related to the incident, and
  • The beneficiary has not received and does not expect to receive any other settlements, judgments, awards, or other payments related to the incident.

By choosing this option, a beneficiary gives up the right to appeal the fixed payment amount or request a waiver of recovery for the fixed payment amount.

For more information, click here.

CMS Extends Reporting Deadlines for Liability Insurance – Again
September 30, 2011, by Mary Re Knack

The new trigger dates are based on gross Total Payment Obligation to Claimant (TPOC) amounts (settlement/judgment/other payment obligation):

  • TPOC greater than $100,000 – no change – Payment obligations as of October 1, 2011 (§111 reporting to begin January 1, 2012)
  • TPOC over $50,000 – Payment obligations as of April 1, 2012 (§111 reporting to begin July 1, 2012)
  • TPOC over $25,000 – Payment obligations as of July 1, 2012 (§111 reporting to begin October 1, 2012)
  • TPOC over $5,000 (minimum threshold) – Payment obligations as of October 1, 2012 (§111 reporting to begin January 1, 2013).

For more information, click here.

CMS issues guidance for reporting of Cases involving Exposure, Ingestion or Implantation and December 5, 1980
September 30, 2011 (revised October 11, 2011), by Mary Re Knack

There is no MSP recovery claim where:

  • All exposure or ingestion ended or the implant was removed before December 5, 1980; and
  • There is no claim or specific release of exposure, ingestion or an implant on or after December 5, 1980; and
  • There is either no release for the exposure, ingestion, or an implant on or after December 5, 1980; or where there is such a release, it is a broad general release (rather than a specific release) which effectively releases exposure or ingestion on or after December 5, 1980.

For more information, click here.

CMS issued its first guidance about the use of Liability Medicare Set-aside Arrangements (LMSA)
September 29, 2011, by Mary Re Knack

If a treating physician certifies in writing that a claimant, as of the date of claim resolution, does not require any future injury related care, then the obligation to consider CMS’ interest in future payments has been satisfied and the parties can rely on such certification. Be sure to keep a copy in the file.

CMS issues $300 Threshold on Liability Settlements
September 6, 2011, by Mary Re Knack

CMS will not pursue any recovery for a settlement, judgment or other payment under $300 if all the following are met:

  • The claim is is related to an alleged physical trauma-based incident, not an alleged exposure, ingestion, or implantation, and
  • There are no additional settlements related to the same alleged incident, and
  • CMS has not already issued a demand letter.

For more information, click here.

CMS Issued Version 3.2 of the NGHP User Guide
August 17, 2011, by Mary Re Knack

For more information, click here.

Centers for Medicare and Medicaid Services Grants a One Year Reprieve for Liability Insurance
November 15, 2010, by Mary Re Knack

Centers for Medicare and Medicaid Services (CMS) grants a one year reprieve for liability insurance. Now, only those TPOC liability payment obligations occurring after October 1, 2011 (previously October 1, 2010) have to be reported. Further, RREs do not have to begin reporting until January 1, 2012 (previously January 1, 2011). The dates for ORM reporting have not been extended.

In addition, CMS has extended the deadlines of the thresholds for reporting under Section 111 for Liability and Workers Comp TPOCs by one year. Details are below:

  • Those TPOCs that occur prior to January 1, 2013 and are for less than $5,000 are exempt from reporting
  • Those TPOCS that occur between January 1, 2013 and December 31, 2013 and are for less than $2,000 are exempt from reporting
  • Those TPOCS that occur between January 1, 2014 and December 31, 2014 and are for less than $6,00 are exempt from reporting
  • All TPOCs that occur after January 1, 2015 must be reported irrespective of the amount

Finally, CMS has also extended the thresholds for reporting under Section 111 for Workers Comp ORM and for Liability and Workers Comp TPOCs by one year until December 31, 2012.

For more information, click here.

Centers for Medicare and Medicaid Services Delays RRE Report Submissions
February 22, 2010,
by Mary Re Knack

On February 16, 2010 the Centers for Medicare and Medicaid Services (CMS) advised that testing for Required Reporting Entities (RREs) to submit reports may continue through 2010, now to be completed by December 31, 2010. In effect CMS has pushed back the date for RREs to submit their reports from April 1, 2010 to January 1, 2011. While we do not yet know what claims will need to be reported, we anticipate CMS will answer that question shortly.

In addition, CMS advised that it will post the next version of the Section 111 NGHP User Guide and other alerts during the week of February 22, 2010.

For more information, click here.