WASHINGTON, DC – The Medicare Advocacy Recovery Coalition (MARC) today applauded the introduction of the Provide Accurate Information Directly Act (PAID Act) (H.R. 1375), a bipartisan bill to improve the Medicare Secondary Payer process and provide a clear framework for communication among involved stakeholders.
“The PAID Act will ensure that there is a clear and functional system for sharing information between settling parties and Medicare stakeholders,” said Re Knack, Chair of MARC, DRI Member and Chair Emeritus for DRI’s MSP Task Force. “We thank Representatives Ron Kind (D-WI) and Gus Bilirakis (R-FL) for their leadership in helping ensure claims can be resolved promptly and beneficiaries can receive what they are owed.”
The Medicare Secondary Payer (MSP) policy was designed to ensure that the Medicare and Medicaid programs do not pay for healthcare expenses for which another party is responsible. However, the process by which the Centers for Medicare and Medicaid Services (CMS) recuperates payments from settling parties for claims related to Medicare Advantage, Part D, or Medicaid plans is currently broken. Settling parties have no way to find out if a beneficiary is even enrolled in a MA or Part D plan much less which plan a beneficiary may be enrolled in. Without this information, parties will not even know they have an obligation to reimburse the plan, or what plan they must reimburse. This results in situations where a party may close a claim only to find out a year or more later that they have a reimbursement obligation.
For beneficiaries seeking care for conditions unrelated to the original settlement, this could result in care delays, as both the settling party and CMS try to reconcile their respective records.
The PAID Act offers a commons sense solution to this issue by requiring CMS to disclose to the settling party which plan a beneficiary is enrolled in through the Section 111 query process, a system that already exists to share information between Medicare and third parties.
“We urge Congress to pass this bipartisan legislation, achieve a more efficient solution for beneficiaries, taxpayers, and employers,” Knack concluded.
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When a beneficiary is injured, and another party is supposed to cover their healthcare expenses – such as in a worker’s compensation claim – Medicare’s legal responsibility to pay is “secondary.” Unfortunately, the current Medicare Secondary Payer (MSP) policy is convoluted and confusing, creating problems and inefficiencies for beneficiaries, settling parties and taxpayers alike. That’s why MARC exists: to support commonsense reforms to fix this broken system. MARC’s membership represents virtually every sector of the MSP regulated community including attorneys, brokers, insureds, insurers, trade associations, self-insureds and third-party administrators. For more information on MARC, please visit www.MARCcoalition.com.