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Medicare Regulations

While data reporting for Medicare Set-Asides (MSAs) have been delayed until 1/1/2011, the Centers for Medicare and Medicaid Services will be enforcing allocation reports and compliance for all casualty programs. Are you ready for the regulations?

Recent legislation (Public Law No. 110-173), has expanded the definition of the

administrative requirements designed to protect the Medicare system from medical expenses considered the primary obligation of private sector plans, including insured and self-insured workers’ compensation, liability and no fault plans.

The Social Security Act requires that parties to a settlement protect Medicare's interests as a secondary payor to other available insurance plans. Protecting Medicare's interests has meant reimbursing monies paid by Medicare as "conditional payments" and establishing an allocation for the payment of future Medicare eligible medical expenses.

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA-111) creates reporting requirements that will enable Medicare to examine settlements, judgments and awards to ensure that conditional payments are identified and reimbursed. If the settlement does not contain an allocation, Medicare has a statutory right to recover up to the entire amount of the settlement, judgment or award. The Act does not change current practices regarding Medicare Set-Aside agreements (MSA), however it emphasizes positive enforcement of protection and recovery measures for Medicare with respect to all classes of casualty claims. Keep informed by visiting the CMS website for updates.

Newly Enforced Requirements:

The Responsible Reporting Entities (RRE’s) or its designated agent must make a specific determination for each claimant under a workers' compensation, liability or PIP (personal injury protection)/no-fault program regarding whether the party is a Medicare beneficiary.

For Medicare beneficiaries, information regarding the claimant and claim must be reported to the Center for Medicare and Medicaid Services (CMS) so that a determination can be made regarding coordination of benefits and applicable recoveries.

A penalty of $1,000 per claim per day will be assessed against any applicable plan for cases of non-compliance.

Choose our independent, experienced team of professionals that are committed to work for you. We have over 30 years of experience in administering the entire claim adjudication process, including MSA’s. Our MSA Best Practices have been recognized throughout the industry as a leading source of quality management. We understand and appreciate the importance of your time, and we are available to compliment your existing resources to reduce your costs on each and every claim file.

Blackburn Group, Inc.
6709 Glenkirk Road, Baltimore, MD 21239-1411
(443) 841-5255, Email: slecompte@blackburngroup.com

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