Showing posts with label Payment. Show all posts

Sunday, January 5, 2014

Comments Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal

Comments submitted concerning the Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal are now available for review.

Summary

This interim final rule with comment period specifies the process and timeline for expanding CMS' existing Medicare Secondary Payer (MSP) Web portal to conform to section 201 of the Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act). The interim final rule specifies a timeline for developing a multifactor authentication solution to securely permit authorized users other than the beneficiary to access CMS' MSP conditional payment amounts and claims detail information via the MSP Web portal. It also requires that we add functionality to the existing MSP Web portal that permits users to: notify us that the specified case is approaching settlement; obtain time and date stamped final conditional payment summary forms and amounts before reaching settlement; and ensure that relatedness disputes and any other discrepancies are addressed within 11 business days of receipt of dispute documentation.

Docket ID:CMS-2013-0199

Topic(s):Kidney Diseases, Medicare, Physician Referral, Reporting and Recordkeeping Requirements

Document Type:Rule

Received Date:Sep 20, 2013

Start-End Page:57800 - 57806

Comment Start Date:Sep 20, 2013

Comment Due Date:Nov 19, 2013

Comments submitted included those of:

-Progressive Medical

-AAJ

-Property Casualty Insurers of America

-Crowe Paradis

-Franco Signor

-MARC

-CA State Compensation Fund

-NAMSAP

-DRI

-Allsup

-RIMS

-FCC

-Garretson Resolution Group

-AIA

-UWC

Click here to view all contents individually.

Found on

Monday, September 23, 2013

CMS Publishes Rules to MSP Payments Under the SMART Act

Medicare has published proposed Rules to governor obtaining information concerning the conditional payments as required by the recently implemented SMART Act. The Regulations expand the bureaucratic framework for Medicare beneficiaries and their representatives in order to obtain and appeal information on condition payment demands from the government.

The Rules are effective on November 10, 2013 and the comment period closes at 5pm on that date.

The government will be establishing a multifactorial implementation process to keep information secure: DX Codes, provider names. dates of service and conditional payment amounts. Ultimately, it appears that the process will be yet another hurdle to obtain information for workers' compensation claims and release the beneficiary from government liability for medical expenses.

The proposed CMS Rules can be reviewed at: https://www.federalregister.gov/articles/2013/09/20/2013-22934/medicare-program-obtaining-final-medicare-secondary-payer-conditional-payment-amounts-via-web-portal

….

Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

US Supreme Court Asked to Review MSP Preemption Issue (workers-compensation.blogspot.com)
9th Circuit Vacates MSP Injunction Against CMS for Medicare Reimbursement (workers-compensation.blogspot.com)
Medicare To Punish 2,225 Hospitals For Excess Readmissions (workers-compensation.blogspot.com)
The Public and the Conflict over Future Medicare Spending (workers-compensation.blogspot.com)
Democrats Jump on the 'Death Panel' Bandwagon (workers-compensation.blogspot.com)

Monday, December 5, 2011

US Supreme Court Maybe Asked to Rule on CMS Issue: "The Doctrine of Equitable Allocation"

The 6th Circuit Court of Appeals has ruled that The Center for Medicare and Medicaid Services (CMS) is entitled to complete reimbursement of Medicare payments under the Medicare Secondary Payer Act (MSP) from a liability claim even though the beneficiary claimed that the settlement required allocation due to the law allocating liability.

I reported on this case last week:
The Doctrine of Equitable Allocation Not Applicable in a Medicare Secondary Payment Reimbursement Claim

A recent news report indicates that appeal maybe sought to the US Supreme Court.

Medicare payment ruling may hinder workers comp settlements

"A federal appeals court decision that allows Medicare to claim nearly half of a man's liability settlement could hinder insurers' ability to settle such claims and may be an issue that reaches the U.S. Supreme Court."

read more:

Monday, June 20, 2011

CMS Recovery Contractor Publishes New Rights and Responsibilities Letter

The Centers for Medicare and Medicaid Services (CMS) has now posted its newly revised Rights and Responsibilities letter. The letter complies with the Court's Order in Haro v. Sebelius which restrict the application of interest while an appeal is pending. The letter no longer demands that an attorney withhold settlement proceeds from a case.

CMS employs outside contractors to collect conditional payments that Medicare has paid and for which it is only secondarily responsible

"The Medicare Secondary Payer Recovery Contractor (MSPRC) protects the Medicare trust fund by recovering payments Medicare made when another entity had primary payment responsibility. The MSPRC accomplishes these goals under the authority of the Medicare Secondary Payer (MSP) Act. The MSPRC identifies and recovers Medicare payments that should have been paid by another entity as the primary payer either under a Group Health Plan (GHP) or as part of a Non-Group Health Plan (NGHP) claim which includes, but is not limited to Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation. The MSPRC does not pursue supplier, physician, or other provider recovery'."

For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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