Changes in Medicare Secondary Payor administration
One of the perennial annoyances in personal injury law practice is the need to deal with the Medicare bureaucracy regarding the claims for reimbursement out of personal injury recoveries of a portion of funds paid by Medicare for medical expense. It’s bad enough to have to send them money, but it’s worse to have to deal with the delay and mindlessness of the bureaucracy. Today I was alerted to a change in the way Medicare deals with those reimbursement claim.
The change in Medicare reimbursement protocol outlined below is only one of many examples of how public and private health care agencies (agencies) are outsourcing their efforts to expose the beneficiaries and attorneys involved in any settlement where the agencies have made conditional payments for injury-related care. These agencies continue to pour substantial resources into the recovery efforts associated with liability and workers compensation settlements.
The Centers for Medicare & Medicaid Services (CMS) awarded a single contract for a national Medicare Secondary Payer Recovery Contractor (MSPRC) to the Chickasaw Nation Industries, Inc.– Administrative Services, LLC (CNI).
Effective October 2, 2006, CMS transitioned all Medicare Secondary Payer (MSP) recovery workloads, both Group Health Plan (GHP) and non-GHP, to a national MSPRC (and away from the dozen or so contractors that were handling the MSP recovery effort regionally). The new, national MSPRC will focus its initial efforts on Workers Compensation, No-Fault and Liability cases, including product liability and medical malpractice cases. The lead (regional) recovery contractor with which you have had contact in the past will no longer be responsible for this activity.
For all new MSP initial recovery demand letters issued on or after the implementation date for the MSPRC (October 2, 2006), you should respond to the entity which issues the recovery demand letter to you. Except for provider, physician, or other supplier MSP recovery claims and a limited number of GHP debts in certain states, this will routinely be the MSPRC.
- The national MSPRC will have responsibility for all new MSP recovery demand letters issued on or after the implementation date for the MSPRC (October 2, 2006), as well as all subsequent CMS actions on those recovery claims. The two exceptions to this are recovery demand letters issued by the MSP Recovery Audit Contractors (RACs) implemented as a demonstration under the Medicare Modernization Act of 2003 and MSP recovery demand letters issued by the claims processing contractors to providers, physician, and other suppliers. The RACs will continue to have responsibility for certain MSP GHP based recovery demands for the States of California, Florida, and New York. The three MSP RACs are: Diversified Collection Systems (California), Public Consulting Group (Florida), and Public Consulting Group (New York).
NOTE: The responsibility for all pending MSP recovery cases where a recovery demand letter has not yet been issued will, aside from the two exceptions noted in the preceding paragraph, be the responsibility of the MSPRC. (Please note that a letter providing the amount of Medicare’s conditional payments in connection with a workers’ compensation or liability or no-fault insurance case is not a recovery demand letter.) This responsibility is in line with the MSPRC’s responsibility for the issuance of all new MSP recovery demand letters issued on or after October 2, 2006 (again, with the two exceptions noted in the preceding paragraph).
- Due to systems issues, the Medicare contractors listed immediately below will continue to have responsibility for all further CMS collection actions with respect to MSP recovery claims where the initial recovery demand letter was issued prior to the implementation date of the MSPRC (October 2, 2006). This includes responsibility for the "Notice of Intent to Refer Debt to the Department of Treasury" where a recovery claim is not repaid timely. The RACs will also continue to have this responsibility for all RAC-initiated MSP recovery claims.
- Empire – Syracuse NY or Harrisburg PA
- First Coast Service Options – Jacksonville FL
- Mutual of Omaha – Omaha NE
- Palmetto – Augusta GA or Columbia SC or Columbus OH
- Trailblazer – Denison TX
The MSPRC will have responsibility for all further CMS collection actions for MSP recovery demand letters issued before the implementation date for the MSPRC (October 2, 2006) unless the recovery demand letter was: (1) issued by one of the Medicare contractors listed immediately above; (2) issued by one of the RACs; or (3) issued to a provider, physician, or other supplier.
Once a recovery claim is referred to the Department of the Treasury, the contractor which issued the recovery demand letter and the notice of intent to refer the debt to Treasury will take no further collection action. You should direct any further correspondence to the Department of the Treasury (or its contractor if you have received correspondence from an entity under contract to the Department of the Treasury).
Contact Information for the MSPRC:
MSPRC telephone access became available on October 2, 2006. The number for the MSPRC’s dedicated call center is 1-866-MSP-RC20 (1-866-677-7220), available from 8AM to 8PM Eastern time, Monday through Friday, with the exception of holidays.
The MSPRC is a recovery contractor. See http://www.cms.hhs.gov/COBGeneralInformation/ for further information about the COBC, including contact information, attorney information, etc. The COBC’s toll- free line is 1-800-999-1118 (TTY/TDD 1-800-318-8782 for the hearing and speech impaired).
The first priority of the MSPRC will be to address previously submitted notices of settlement and to make a formal Medicare demand. The CMS understands the need to identify Medicare’s final claim and to disburse settlement proceeds.
The new national recovery contractor will be: MSPRC Liability, P.O. Box 33828, Detroit, MI 48232-3828,Telephone: 1-866-MSP-RC20 (1-866-677-7220).
The Shigley Law Firm represents plaintiffs in wrongful death and catastrophic injury cases statewide in Georgia, and in other states subject to the multijurisdictional practice and pro hac vice rules in each state. Ken Shigley was designated as a "SuperLawyer" in Atlanta Magazine and one of the "Legal Elite" in Georgia Trend Magazine. He is a Certified Civil Trial Advocate of the National Board of Trial Advocacy, Chair of the Southeastern Motor Carrier Liability Institute and former chair of the Georgia Insurance Law Institute. He particularly focuses on cases arising from truck wrecks and accidents (tractor trailers truck wrecks, semi truck wrecks,18 wheeler truck wrecks, big rig truck wrecks, log truck wrecks, dump truck wrecks.