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Compliance with the Medicare Secondary Payer Act: What's New?
Presented by Christine Hummel
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Course Description
Length: 2h 5min Published: 2/8/2023 
Complying with the Medicare Secondary Payer Act can be complex and failure to adhere to its requirements can lead to some dire consequences. This presentation gives attorneys handling Medicare issues an in-depth look at the requirements in the Medicare Secondary Payment Act. The program starts with Medicare basics and its eligibility requirements before diving into the three elements within the statute: the requirement for Section 111 reporting, the requirement to reimburse Medicare liens, and the requirement to keep Medicare secondary to a settlement under certain circumstances.
Learning Objectives
* Know the basics of Medicare and its eligibility requirements
* Learn how to comply with the requirement for Section 111 reporting
* Understand how and when to keep Medicare secondary to a settlement under the Act
Speaker Q&A
Question
I know that Medicare does allow an "attorney fee" as a cost to be deducted from the initial Conditional Payment Amount. This would be a simple matter to calculate if the client actually paid a flat or hourly fee for this service. However, how is this handled when the fee arrangement is, as is standard in injury claims, for a contingent fee? Is the deduction even available for such a fee, since the client is not actually paying that amount out of pocket but rather it is being deducted from the gross settlement amount? If it is, how is it calculated and deducted from the initial C.P.A.?
Thanks.
PP
- PaulP
Answer
The Medicare A/B conditional payment amount is reduced proportionately for attorney’s fees and costs; not dollar for dollar. Example: If the combined fee and costs paid by the client are 42%; the final demand amount for the A/B conditional payment amount will be reduced proportionately by 42%.
- Christine Hummel
Question
I still don't understand why M.S.P.R.C./C.O.B.-R doesn't also include the advantage plan (i.e. Part C) carrier, if any, in their lien search for the Conditional Payment Amount. It's getting where it's almost not worth taking personal injury claims where the client has Medicare. There's just too much work and risk involved. smh.
- PaulP
Answer
At this time there is no national contractor for Part C and D lien recovery. This is because the Part C and D plans are administered by private health companies and all billing information for these plans is located on the billing systems/programs for the individual companies running the plans. It is not feasible to sync up all these different systems and platforms. So unfortunately I do not see obtaining Part C and D lien information getting any easier any time soon.
- Christine Hummel
Question
Any tips on accessing the Patient Portal on the website? A few years ago it was fairly simple. Now it seems they want all kind of verification of ID by the attorney to gain access to a case, inc. making a phone call to Experian, etc. I don't understand the "ID paranoia" of late by Medicare.
- PaulP
Answer
There is a patient portal for medicare recipients that the Medicare beneficiary creates on Medicare.gov. This patient portal gives some access to conditional payment data located in the MSPRP portal. In order for an attorney to access the Medicare beneficiary’s account they must have written permission from the beneficiary and have the user name and password the beneficiary established for their account. If an Attorney (or any person) would like to gain access to conditional payment information on the MSPRP they must be properly vetted by the federal government. No access to the MSPRP portal will be provided until proper vetting takes place. And an additional, higher vetting level, is required to obtain copies of letters and see detailed lien information. The vetting system for the MSPRP has been in place for several years and has not changed.
- Christine Hummel
Question
As a plaintiff's attorney, our firm has noticed that 3rd party liability carriers have started to notify CMS when a settlement is reached. Normally, that's fine but when we have a pending UIM claim, it's prompting CMS generate a demand. How should we be handling that? I thought it shouldn't go into demand until we have BOTH the liability and the UIM claim resolved.
- MelissaD
Answer
Regarding Medicare conditional payment searches, each settlement is required to do it’s own lien search. Therefore, it is appropriate for the Medicare lien recovery contractor to demand payment on the liability claim prior to resolution of the UIM claim. It is not unusual for each settlement to make a lien payment to Medicare (the liability and UIM settlements). Also, the insurance provider is required to give notice of settlement under its Section 111 reporting requirement timely. Failure to report the settlement timely could result in a financial penalty being assessed against the insurance company. Therefore, the insurance providers are doing the correct thing by reporting the liability settlement at the time that settlement occurs; rather than wait for the UIM settlement.
- Christine Hummel
Presented By:
Christine Hummel
Ferdinand, IN
(603) 758-1410
christine@hummelcs.com
Featured Reviews
"What a task our presenter took on; and she never faltered I was a workers comp applicant's attorney (and w.c.def atty for a smaller part of that) 31 years, and darn, wish I had been given the BiG Picture about medicare's practives, expectations, down to the dirty detail as was presented here, say --20 years ago!!!? Thanks for bundling this info that always seems so arcane, but is in fact so so important to so many lawyers with real people as clients! Yes thanks!"
ROBERT U
"Although this is not my area of practice, this was both understandable and fascinating. I have an older clientele with periodic questions regarding Medicare liens and particularly set asides. Before I couldn’t even understand their questions, and while I’m still not in a position to advise my clients, I know now that their personal injury attorneys have valid, difficult issues to address. "
Joan K
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