Q&A: Michele Adams, Medicare Advocacy Recovery Coalition

Michele Adams

Michele Adams is chairwoman of the Washington-based Medicare Advocacy Recovery Coalition and director of claims management, business strategies and risk management services at Walt Disney World Resort in Orlando, Florida. She recently spoke with Business Insurance Associate Editor Sheena Harrison about how the Strengthening Medicare and Repaying Taxpayers Act, known as the SMART Act, is progressing, along with upcoming challenges related to Medicare Secondary Payer issues. Edited excerpts follow.

Q: What is the status of implementation of the SMART Act?

A: Since President Obama signed the SMART Act in January 2013, the MARC coalition has been working with the Centers for Medicare and Medicaid Services to implement the requirements of the new law. Several of the SMART Act provisions are self-implementing, such as a statute of limitations and the elimination of strict liability for reporting penalties. Yet several other provisions required new CMS regulation or policy.

CMS has already implemented several of the provisions. For example, CMS recently eliminated the requirement that Medicare beneficiaries provide a full Social Security number so that settling parties can navigate the Medicare Secondary Payer Section 111 reporting process. Similarly, the agency has raised the threshold to $1,000, below which Medicare Secondary Payers will not apply to settlements — easing the settlement process for small claims and saving the government millions of dollars in avoided costs of claims recovery.

Q: Is the SMART Act implementation process going as MARC coalition members had hoped when they originally supported the bill's passage? 

A: Several improvements remain pending in the rule-making process. For example, the law calls for an electronic portal to expedite Medicare repayments during the settlement process. Although the law called for the portal to be running by October 2013, the agency has announced a delay in full functionality until 2016. Similarly, the agency continues to work on rule-making, creating the reporting safe harbors and the appeals process for responsible reporting entities.

Q: What challenges remain in the Medicare Secondary Payer compliance process, and where will the MARC coalition focus its efforts?

A: With several rule-makings left to complete, the coalition continues to meet and work with CMS to finalize those rules as soon as possible. Beyond SMART Act implementation, there are a number of secondary payer issues that claims managers will need to watch for. MARC has been actively working on secondary payer issues related to Medicare Advantage Part D prescription drug plans and Medicaid programs so benefits can be appropriately coordinated at the time of settlement with these plans as well.

Q: What advice would you give to risk managers who are trying to stay ahead of the curve on Medicare Secondary Payer issues?

A: Certainly there is no shortage of Medicare Secondary Payer issues affecting the claims process. As the population expands and a greater number of Medicare beneficiaries are in the general population, and in the employee base, we will continue to see a rise in Medicare Secondary Payer claims. Further, numerous other entities, including Medicare Advantage and Part D insurers may seek to assert their interests in settlements. Claims may become more complicated to resolve, and anticipating the numerous entities that may have a lien on settlement proceeds will become increasingly complex. By joining together, claims professionals have already achieved much success in improving the Medicare Secondary Payer process, but our work is not over. We welcome the claims and risk management community working together, through MARC and other advocacy efforts, to ensure that our successes remain, and we continue to improve those areas of concern that still remain.