Recently, Reps. Gus Bilirakis (R-Florida) and Ron Kind (D-Wisconsin) introduced legislation (HR 5881) in the House of Representatives to amend title XVIII of the Social Security Act, specifically in an effort to provide for transparency of Medicare Secondary Payer reporting information. 

Jean S. Goldstein

Bilirakis issued a press release stating that, “[t]his legislation will ensure that beneficiaries, Medicare, and Medicaid have a clear and quick way to identify whether or not a participant has an MSP obligation, and provide information about how that obligation can be resolved.”

This legislation has been primarily driven by the challenges faced with discovering whether a Medicare beneficiary has a Medicare Advantage Plan, Part D plan or even Medicaid. 

At the very root of this issue is the fact that the Centers for Medicare and Medicaid Services provides information regarding Medicare Part A and Part B, which assists with discovering conditional payments Medicare has made. But CMS does not provide information about the supplemental plans for which a Medicare beneficiary is enrolled. 

HR 5881 proposes that CMS share information regarding enrollment in MAP, Part D and Medicaid to assist with the timely discovery of conditional payments and liens. 

As we have seen and written about here on our blog, we are consistently seeing MSP litigation and aggressive recovery efforts throughout the country. The timely sharing of information and ultimate identification of a beneficiary’s enrollment in supplemental plans would certainly decrease the amount of litigious MSP recovery efforts, as well as the concerns of double damages.

For now, HR 5881 has been referred to the Committee on Ways and Means, and the Committee on Energy and Commerce. The bill text is not yet available. We will be sure to keep you updated on any changes or movement involving the legislation. 

In the meantime, from a Medicare compliance standpoint, we offer the following best proactive practices as related to conditional payments/liens and primary payers’ MSP obligations:

• Do not wait until settlement of a claim to identify all possible conditional payments. Medicare conditional payment/lien investigation and resolution should be done well in advance of settlement discussions.
• Review all medical bills and understand all related work injury treatment.
• Create an open dialogue with the injured worker or his counsel, if represented, inquiring about all plans a Medicare beneficiary is enrolled in. The timely discovery of MAP, Part D and/or Medicaid enrollment can benefit all settling parties.
• Create internal processes on how to timely handle conditional payments, MAP recoveries and other liens.

Conditional payment recoveries and liens can be challenging, given the unknown factors, investigation, consultation, and need for a thorough working knowledge and understanding of a variety of recovery processes. For this reason, it is imperative that conditional payments and other liens are handled properly and with established proactive processes to avoid unnecessary costs, litigation expenses and undue delay in the resolution of claims.

Jean S. Goldstein is a CMS compliance manager and staff attorney for Medval. This blog post is republished here with permission.