Currently, Medicare beneficiaries who have pending claims with third parties responsible for their injuries face settlement delays. The parties cannot determine how much of the settlement is to be used to reimburse Medicare, because Medicare has not been prompt in providing information on the amounts of the benefits it claims to have paid. The result has been to delay settlements between Medicare beneficiaries and tortfeasors.
Congress provided a solution to this problem in H.R. 1845, which was signed into law on Jan. 10, 2013. The law will take effect in 2014.
The new law requires HHS to provide the settling parties with the amount of payments for MSP claims on behalf of the Medicare beneficiary during the settlement process. This will allow the parties to settle and repay Medicare quicker.
The law requires the use of a website to determine the “final condition reimbursement amount” payable by the Medicare beneficiary. The website will contain all Medicare information on claims and payments in as timely a manner as possible but not later than 15 days after Medicare pays the relevant claim.
HHS is also required to promulgate regulations establishing an appeal and appeals process for MSP determinations based on the law’s provisions relating to liability insurance (including self-insurance), no-fault insurance and workers’ compensation laws and plans.
If the Medicare participant or his or her representative believes there is a discrepancy with the reimbursement amount, he or she must provide documentation explaining the discrepancy and propose how to resolve it. HHS must then determine whether there is a reasonable basis to include or remove claims on the statement of reimbursement within 11 days.
HHS is required to promulgate final regulations to carry out these provisions by Sept. 10, 2013. For more information see the Coordination of Benefits Handbook, section 530.