February 2, 2018 – Medicare’s Commercial Repayment Center (CRC) Contractor Transitioned to a New Provider
The new Commercial Repayment Center Contract was awarded to Performant Recovery, Inc. to handle both the Group Health and Non-Group Health Plan conditional payments with ongoing responsibility for medicals (ORM) on October 10, 2017. The transition completed on February 7, 2018.
December 2017 – Medicare Announced new Medicare Health Care Identification Numbers will be issued in 2018
At the end of 2017, Medicare announced they will be issuing new Medicare HICN cards which remove the beneficiaries Social Security Number and provide a new identification number. The new HICN numbers will be issued between April 2018 and April 2019. How this will affect the MSP Compliance is unknown, more is to come!
July 10, 2017 – Medicare issued the updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, Version 2.6
Medicare updated the WCMSA Reference Manual to clarify policy and procedures regarding workers’ compensation Medicare Set Asides. The biggest changes seen affected the expectations of Hearings on the Merits, updated the requirements for Spinal Cord Stimulator pricing, and changed the Re-Review policy.
Medicare amended Section 4.1.4 regarding the Hearing on the Merits of a case. Medicare, in the past accepted the decision of state judges pertaining to the future medical interests. The language was changed to allow Medicare the right to review the decision and determine whether that decision protects Medicare’s interests.
Medicare amended Section 9.4.5 to include further directives for pricing Spinal Cord Stimulators, allowing MSA’s to allocate for replacement of rechargeable stimulator units at a rate of every 9 years. This is an improvement from the prior replacement rate of every 7 years across the board.
Medicare amended Section 16.0 to add the Amended Review. Previously, Medicare would not review new medical records dated after the approved MSA was submitted for review. The amendment allows new medical records to be submitted for review when the treatment has changed the MSA plan by 10% or $10,000.00, whichever is less, and the MSA approval letter is at least one year old, but nor more than 4 years old.
January 10, 2013 – The SMART Act Was Signed into Law
On January 10, 2013, President Obama signed the SMART Act into law. The SMART Act permits parties to obtain a final lien demand for Medicare Conditional Payment Liens prior to settlement. Medicare will be required to provide a final lien amount within 65 days of a request so that to allow the settling parties to better prepare reserves to cover the lien prior to settlement. The Act also introduced the right to appeal the lien amount, and set a threshold for MSP claims, in that if the lien is small, Medicare will not pursue reimbursement. The SMART Act will amended the penalty language for failure to comply with reporting requirements to read that the fine will be “up to $1,000.00” per day at the discretion of the Dept. of Health and Human Services. This protects Carrier/Employers who made good faith efforts to comply, who should not be severely penalized. The SMART Act also requires Medicare find an alternative to SSNs and Medicare numbers for identifying beneficiaries to protect their sensitive personal information. Lastly, the SMART Act established a 3 year statute of limitations from the date of reporting for all MSP claims, which is reduced from the 6 year statute of limitations.
October 2, 2012 – Medicare Part D began covering Benzodiazepines and Barbiturates
On October 2, 2012, CMS published a Memo, “Transition to Part D Coverage of Benzodiazepines and Barbiturates Beginning in 2013”, stating that as of January 1, 2013, Part D will begin covering barbiturates and benzodiazepines. Furthermore, as of June 1, 2013, CMS will require that Medicare Set Asides include funds for benzodiazepines and barbiturates now covered by Medicare Part D