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How SMART Act provisions will change Medicare Secondary Payer process

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Employers will benefit soon from a statute of limitations on Medicare Secondary Payer cases but may have to wait before seeing other advantages of the Strengthening Medicare and Repaying Taxpayers Act, said Roy Franco, co-chair of the Washington-based Medicare Advocacy Recovery Coalition.

Mr. Franco and other panelists will discuss the changes in the Medicare Secondary Payer process during a session this afternoon at the Risk & Insurance Management Society Inc. annual conference. The presentation, “Implementation of the Strengthening Medicare and Repaying Taxpayers Act (SMART Act),” will be held at 3:45 p.m.

Speakers also will include William Zachry, vice president of risk management at supermarket operator Safeway Inc. in Pleasanton, Calif.; Nathan Bacchus, New York-based state and regulatory affairs associate for RIMS; and Cheryl Berman, San Diego-based regional risk manager for building materials supplier ProBuild Holdings Inc.

The new key legislation, which was signed into law in January by President Barack Obama, contained portions of the SMART Act, which aims to simplify the process of reimbursing the Centers for Medicare and Medicaid Services. Under Medicare Secondary Payer rules, CMS holds insurers and self-insured employers responsible to pay for a Medicare beneficiary’s medical treatment related to workers compensation or liability cases.

The SMART Act established a three-year statute of limitations for CMS to seek collections from employers and insurers, and that time limit is set to begin in July, Mr. Franco said. The deadline will help employers close workers comp and liability cases, he said, rather than being held responsible for a Medicare claimant’s medical care for many years after their claims have been settled.

“If an employer gets a document now from Medicare and it’s on a case that’s been reported more than three years ago, the employer should be able to basically get it dismissed,” Mr. Franco said.

Regulations are still being considered and drafted for other portions of the SMART Act, Mr. Franco said. Those include an appeal process for employers and insurers that disagree with a CMS demand for reimbursement, and safe harbor provisions for payers that are unable to identify whether a claimant is Medicare-eligible.