4-7-2011; 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?

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:

       Obtaining CMS’ reimbursable conditional payment amount—this will help the parties confirm amounts which will be owed for past medical. Under CMS’ current process, the parties generally cannot obtain the exact reimbursable conditional payment amount until after the claim settles.

       Requiring CMS to respond  to requests  for conditional payment information within set timelines—finally you won’t be stuck in the purgatory of never knowing when you will receive information you need to resolve past payments, hopefully within 120 days or less;

       MSP appeal rights—when you receive the $100k MSA ruling for a person who hasn’t had a surgical procedure, you may have somewhere to turn as review through an administrative law judge and administrative review board, and access to judicial review in the district court of the United States is proposed in a manner which would be similar to the appeals procedure under regulations for hearing procedures respecting notices of determinations of nonconformance of group health plans.

       MSP threshold exemptions—the SMART Act would require that CMS establish an annual MSP threshold exemption amount below which MSP compliance would not be necessary. The SMART Act’s proposal of a yearly MSP threshold exemption amount replaces the flat $5,000 monetary threshold exemption proposed last year.

       MSP statute of limitations—you would no longer have to worry about someone looking into a claim well after all parties have retired as the SMART Act would establish a Three (3) year Statute of Limitation for MSP Claims.

We will keep you advised of changes as they occur and as previously noted, Shawn R. Biery has completed course work and testing from two sources to obtain his 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.