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Sheena Harrison

Proposed rule issued for right of appeal in Medicare Secondary Payer cases

December 27, 2013 - 2:55pm


The Centers for Medicare and Medicaid Services has issued a proposed rule for an appeal process related to Medicare Secondary Payer claims.

The rule, published Friday in the Federal Register, is based on provisions outlined in the Strengthening Medicare and Repaying Taxpayers Act, a bill enacted in January that aims to ease the Medicare Secondary Payer compliance process.

The Medicare Secondary Payer Act requires insurers and self-insured employers to notify CMS of any workers compensation or liability claim settlement involving a Medicare-eligible individual. CMS can require that such payments reimburse the agency for medical care that it paid on a claimant’s behalf.

The SMART Act includes an appeal process for employers and insurers that disagree with a CMS demand for reimbursement. Employers and insurers previously did not have that right under Medicare Secondary Payer law, although beneficiaries did have a right to appeal.

CMS will accept comments on the proposed rule through Feb. 25, 2014, according to the Federal Register.