4-19-2011; UPDATE—Will changes to the Medicare Secondary Payer Statute assist in resolving Medicare issues and finally give us a way to appeal what are sometimes incomprehensible MSA values?

As previously reported, on March 14, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) (H.R. 1063) was introduced in the U.S. House of Representatives. The SMART Act proposes major amendments to the Medicare Secondary Payer Statute (MSP). Track progress here: http://www.govtrack.us/congress/bill.xpd?bill=h112-1063       

The SMART Act’s reform proposals target multiple areas of MSP compliance including: Among its provisions, the proposal would:

·         Require CMS to respond  to requests  for conditional payment information within set timelines

·         Provide MSP appeal rights

·         Set MSP threshold exemptions

·         Set MSP statute of limitations

Debate continues behind the scenes but some grumbling regarding streamlining the process creating more costs for taxpayers appears to be misguided in the mind of this writer as it seems to be a cop-out for someone who doesn’t want to be held accountable for the work CMS employees are paid to perform. Plus noting that CMS can fine payers up to $1,000 per day for failing to provide complete information, there will be a pool of funds for payment of bills outside the statute of limitations unless CMS simply doesn’t track anything. The legislation would impose safe harbors to prevent fines against payers that are making good-faith efforts to provide the information so those who cooperate with the system will be safe and there is an incentive to provide all information rather than play “medical bill roulette” and hope for the statute to run. The proposes 3-year statute of limitations is a reasonable time frame on legal actions to be brought by the U.S. when compared to other SoLs.


We will continue to keep you advised of changes as they occur and as previously noted, Shawn R. Biery has been granted the Medicare Set-aside Consultant Certified (MSCC) credential. Please feel free to contact Shawn R. Biery, J.D., M.S.S.C. at sbiery@keefe-law.com with any questions regarding Medicare Set-Aside issues.