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Bill would relax Medicare claims reporting rules


(CORRECTED) WASHINGTON—A bill introduced Wednesday in the U.S. House of Representatives would reform claims reporting rules under Section 111 of the Medicare, Medicaid and SCHIP Extension Act, including giving the government discretion in determining when to impose penalties for rule violations, and imposing a three-year statute of limitations for failing to comply with the rules.

Current law requires insurers or employers to notify the U.S. Centers for Medicare & Medicaid Services when any workers compensation, liability or no-fault claim with a medical component involves Medicare-eligible beneficiaries. Employers and insurers who are deemed responsible reporting entities face a $1,000-per-day penalty per claim for failing to properly notify CMS.

But the Medicare Secondary Payer Enhancement Act of 2010, which was introduced Tuesday, would change language in the law so that the government has enforcement discretion in determining whether to apply the penalty for failing to properly notify CMS.

U.S. Reps. Patrick Murphy, D-Pa., and Tim Murphy, R-Pa., introduced H.R. 4796 with support from the Medicare Advocacy Recovery Coalition, an insurer and employer group that advocates for improvements in the Medicare Secondary Payer program.

The bill also would limit Medicare Secondary Payer recovery efforts to claims of $5,000 or more. Under the measure, CMS would not pursue any recoveries related to claims of less than that amount.

The bill also would protect Medicare beneficiaries by eliminating a requirement that claim notifications to CMS contain claimants' Social Security numbers. Employers, insurers and TPAs have said they fear that obtaining claimant Social Security numbers in liability settlements could open them to liability should the information be misused.

The legislation also calls for CMS to provide claimants, insurers or employers with the amount of a “conditional payment” that the agency will demand before the parties settle a claim. Conditional payments are reimbursements that CMS demands for medical expenses it has paid on behalf of its beneficiaries. Currently, CMS notifies parties of their conditional payment obligations after they settle a claim.

This story corrects errors in a previous online story, “Bill Would Limit Medicare Secondary Payer Fines.”