Mention the term “Medicare Secondary Payer” to a risk manager and the reaction is always the same: “ARGH!”
Many risk managers are frustrated when navigating the complicated
Though this well-established practice was designed to ensure taxpayers don’t foot the bill when another party is responsible, the current process by which Medicare recoups payment for these claims is broken, especially in situations where a beneficiary is covered by a Medicare Advantage or Part D plan. This is because insurers and self-insured entities that are responsible for worker’s compensation, no-fault and liability claims (commonly known as Primary Plans) have no way to figure out whether or not a Medicare beneficiary claimant may be covered by a private Medicare plan. Therefore, it is virtually impossible for them to coordinate benefits or repay Medicare what is owed.
Though Medicare does eventually pass on some information about a claimant’s enrollment in a private Medicare plan through Section 111 quarterly reporting, it is often too late in the Primary Plan claim life cycle. By then, most claims are resolved and the claim itself is closed. This creates
Now, if you’re thinking this is an uncommon occurrence, think again. There are more than 22 million Americans enrolled in a Medicare Advantage plan — about one-third of all Medicare beneficiaries — and an additional 43 million who have a Part D prescription drug plan. The inefficiencies created by this broken system are draining for both payers who want to do the right thing and the Medicare Trust Fund, which isn’t able to recoup what it’s owed.
It doesn’t have to be this way.
Congress has an opportunity to implement some common sense reforms to the Medicare Secondary Payer process by requiring more information sharing between the Centers for Medicare & Medicaid Services and settling parties — such as whether the beneficiary is enrolled in a Medicare Advantage or Part D plan, along with the name and identity of the plan and dates of coverage.
To do so, we need to let Congress know why it’s important to pass the bipartisan Provide Accurate Information Directly (PAID) Act, which accomplishes this exact goal. With just one small legislative change, Congress can create a smoother, speedier and fairer claims process for all parties involved.
The PAID Act is truly a win-win-win scenario for taxpayers, beneficiaries and settling parties. It will save the American taxpayer money by allowing for prompt reimbursement, help Medicare beneficiary claimants avoid unnecessary delays in receiving their settlement, and ensure Primary Plans can close outstanding claims on their books.
I encourage Congress to act quickly and resolve this issue for good.