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Medicare secondary payer compliance: How to deal with an evolving regulatory landscape


With more people entering the Medicare system, the Centers for Medicare and Medicaid Services has increased efforts to protect the Medicare trust funds from depletion. Medicare spent $574 billion providing health care coverage in 2012 and generated $537 billion in income that year. That spending gap is expected to continue far into the future.

The primary tool for recovering money to replenish the Medicare trust funds is the Medicare Secondary Payer Act, a law passed in 1980 requiring CMS to be a secondary payer of workers compensation, liability and no-fault insurance claims. Settlements and judgments that involve Medicare beneficiaries, or those who will soon become beneficiaries, force parties to include reimbursement for medical care that occurred from the date of an injury to the date of a settlement. Also, parties must set aside money for future medical expenses related to a Medicare beneficiary's injury that was covered by a primary insurer or self-insured entity.

This Business Insurance white paper examines some of the many challenges surrounding Medicare Secondary Payer compliance and includes strategies to make the compliance process easier. It also explains the pending legislative and regulatory reforms that could reduce the Medicare reimbursement burden for insurers and employers.

As Medicare Secondary Payer rules continue to evolve, workers compensation payers can adopt best practices to alleviate compliance concerns. Although these strategies might need to be altered based on future court decisions and legislation, they provide the best bet for avoiding problems. View a sample.

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