New MSP Law: Summary

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New MSP Law: Summary  

President Obama has signed legislation (Jan. 10, 2013) that will streamline the Medicare Secondary Payer reimbursement process. A summary of the new law is below.

 

Title II of H.R. 1845 includes the the Strengthening Medicare and Repaying Taxpayers (SMART) Act.

The SMART Act will:

Require CMS to maintain a secure web portal to access claims and reimbursement amounts in a timely fashion.

  • CMS must upload care payments they disperse within 15 days with the required information about the payment.

Streamline the process of obtaining reimbursement amounts.

  • Medicare beneficiaries must notify CMS they are anticipating a settlement no more than 120 days beforehand.
  • CMS then has 65 days to ensure the web portal is up-to-date, but may request an additional 30 days, if needed.
  • Reimbursement amounts are reliable if downloaded from the web portal within three days of settlement.

Provide a process and timeline for discrepancies and appeals.

  • If you provide documentation for discrepancies on the web portal to CMS, it has 11 days to respond.
  • If CMS does not respond in 11 days, the amount calculated by the beneficiary is the correct amount. 
  • An additional appeal process must be established by CMS for reimbursements it attempts to collect from insurance plans.

Create a threshold for collecting any payment amounts by CMS that are below the cost it incurs to collect an average claim.

Readjust the penalty for reporting errors by insurers based on the violation.

Ensure greater privacy for beneficiaries by no longer requiring use of full social security or health id claim numbers. 

Create a three-year limit for CMS to seek any repayments beginning from when they were informed of an anticipated settlement.

 


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