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Medicare Jennifer Pickett MEDICARE Updates Now Coming Fast and Furious Just to think that one year ago, attorneys were cursing Medicare for the frustrating and burdensome regulations imposed on reporting and reimbursement requirements. Don’t get me wrong, I still hear cursing at the offi ce, just not quite as forcefully or frequently these days. In addition to the self-help options available on certain settlements with Medicare benefi ciaries, the Centers for Medicare and Medicaid Services (“CMS”) has developed an online portal that bypasses snail mail and lengthy telephone hold times. Whose blood pressure doesn’t go up after hearing, “your expected wait time is 18 minutes” ? Th e on-line portal allows individuals other than Medicare benefi ciaries themselves to access reimbursement-related information. For example, through the portal, attorneys and carriers are able to download executed Consent to Release forms, obtain conditional payment amounts and request updated lien amounts and fi nal demand letters. In order to access the portal, the following information is required: - benefi ciary’s date of birth; - social security number or Medicare ID; - Medicare’s 15-number case ID (which can be found on any correspondence from CMS once the claim has been reported). In order to request updated conditional payment totals and fi nal demand letters, there must be a Consent to Release on fi le with CMS. Th is portal is very helpful in that it signifi cantly shortens the time period in which we can obtain Medicare’s lien information. CMS has also instituted an automated self-service line that can be accessed through the main number, 1-866- 677-7220. Th e self-service line only provides the last reported conditional payment information and does not allow for requests or updates. In addition to the changes CMS is implementing, Congress is now getting involved. In late December 2012, the U.S. House and Senate passed the Strengthening Medicare and Repaying Taxpayers Act (SMART Act). President Obama signed the bill into law on January 10, 2013. Th e purpose of the SMART Act is to make the new reporting and reimbursement requirements more effi cient by decreasing bureaucratic delays in the process. Th e Act addresses obtaining the Medicare lien amount, creating an annual threshold, reconsidering the civil penalties for noncompliance, and statute of limitations. A. Lien Requests Eff ective October 1, 2013, CMS would have 65 days from receipt of a request for the Medicare lien amount; however, the time period may be extended 30 days after additional notice is provided. After that period, the parties can rely on the reimbursement amount available through the online portal. Th e importance of this provision is that it would require CMS to provide a fi nal lien demand prior to a settlement of the claim. Th ere is also a provision that reporting entities do not have to access or report social security numbers or Medicare ID/health identifi - cations numbers. B. Threshold Eff ective November 20, 2014, certain liability claims will be exempt from reporting and reimbursement, if the claim falls below the annual threshold as calculated by the Secretary of Health and Human Services. C. Civil Penalties Eff ective March 10, 2013, the civil penalties for non-compliance with mandatory insurance reporting requirements would no longer be mandatory; rather, the language would be changed to read “may be subject to a civil money penalty of up to $1,000.00 for each day of noncompliance with respect to each claimant.” CMS is to solicit proposals from insurance professionals as to how to apply the fi nes and outline specifi c practices (e.g., explore the carrier that has made 28 Birmingham Bar Association


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