Compliance with Medicare Secondary Payer Statute after MMSEA Section 111 presented by Roy Franco, Robert Frassetto, Lola Hogan & Jim Price


In This Presentation:

- Medicare Secondary Payer

- MSP Compliance Parts

• Past or reimbursement of “conditional payments” – See 42 USC 1395y(b)(2)(B)(ii)

• Present or “Reporting” – See 42 USC 1395y(b)(8) and 42 CFR §411.25

• Future or protecting Medicare’s interest because “payment [by a primary plan] can reasonably be expected to be made”

– See 42 USC 1395y(b)(2)(A)(ii)

- Medicare Secondary Payer Act and the Medicare, Medicaid, and SCHIP Extension Act of 2007

- What Do Risk Managers and Claims Adjusters Need To Consider in Resolving High Frequency, Low Severity Claims

-General Overview – MSP Statue and Regulations

• Medicare Secondary Payer Statute (42 USC 1395y) has been in effect since December 5, 1980

• The purpose of the statute is to make Medicare a secondary payer to anyone else whenever there is other Health Insurance or Liability Insurance, including:

• Workers’ compensation;

• No-fault insurance;

• Liability insurance (including “self -insurance”)

• An entity becomes a “Primary payer” responsible to reimburse Medicare whenever there has been a settlement, judgment, or other payment for a claim in which:

• Medicare has made a “conditional payment” or

• Where the person may become “Medicare eligible” within 30 months of the settlement (for workers’ compensation)....

Please see full presentation below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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