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On February 18, 2014, CMS’s Financial Services Group announced in an Alert an important change in the reporting threshold for certain liability settlements, judgments awards or other payments required by Section 202 of the Strengthening Medicare and Repaying Tax Payers Act of 2012 (SMART Act). CMS is increasing its current reporting threshold from $300 to $1000. … Read more

The Medicare Secondary Payer (MSP) program is designed to reduce costs to the Medicare program by requiring other insurers of health care for beneficiaries to pay primary to Medicare. It applies in three situations: where there is liability insurance, e.g. for an accident; where there is workers compensation coverage, e.g., for a job related injury; … Read more

On January 10, 2013, President Obama signed legislation for the establishment of a website to provide information to beneficiaries about their Medicare Secondary Payer (MSP) obligations.[1]  While there are exceptions, Medicare generally expects to be reimbursed if it makes a conditional payment for which a third party, such as other insurance or a personal injury … Read more

Advocates have long awaited clarification from the Centers for Medicare & Medicaid Services (CMS) about its rules and procedures for the treatment of future medical expenses related to an accident or injury for which there is third party liability and Medicare has made a conditional payment.  This is because there has been very little guidance … Read more

The Medicare Secondary Payer (MSP) program authorizes the Centers for Medicare & Medicaid Services (CMS) to recover compensation payments from beneficiaries who have private insurance that should be primarily responsible for their medical expenses.[1] In a class action lawsuit brought by Medicare beneficiaries and their attorney to challenge certain harsh MSP collection practices, a federal … Read more

A group of organizations has identified collection practices in the Medicare Secondary Payer (MSP) program that are unnecessarily harmful to beneficiaries.  On April 28, 2011, the Center for Medicare Advocacy, together with the American Bar Association Commission on Law and Aging, the Medicare Rights Center, and the Center for Health Care Rights, wrote to the … Read more

The Medicare Secondary Payer (MSP) program seeks to conserve funds by prohibiting Medicare payment for health care that could be covered by another insurer.  Thus, when a Medicare beneficiary experiences an injury that might be covered by liability, no-fault, or workers’ compensation (hereinafter “liability”) insurance, Medicare will pay conditionally for her medical services, but recovers … Read more

The Medicare Secondary Payer (MSP) law was enacted by Congress to assure that Medicare does not pay for medical expenses that could be covered by private insurance. When beneficiaries are injured, Medicare will pay for care related to the injury if payment by these private insurances cannot be expected promptly, but it expects to recover … Read more