WASHINGTON, DC – In a letter addressed to Senators Tim Scott (R-SC) and Ben Cardin (D-MD), seventeen organizations and companies representing the Medicare Secondary Payer-regulated community urged Congress to pass the bipartisan Provide Accurate Information Directly (PAID) Act (S.1989/H.R.1375).
“On behalf of the Medicare Advocacy Recovery Coalition (MARC), we are writing to thank you both for your continued leadership in advocating for the Provide Accurate Information Directly Act and to communicate our strong support for this important legislation,” the letter reads. “As you know, the current law continues to create an inefficient system for all parties trying to navigate the Medicare Secondary Payer statute which involves Medicare Advantage and Medicare Prescription Drug Benefit claims. The passage and enactment of the bipartisan PAID Act is needed to correct this inefficient process and ensure that every stakeholder is given the accurate information needed to resolve claims quickly and save taxpayers millions of dollars in the process.”
About the PAID Act
Currently, when a Medicare beneficiary with a Medicare Advantage or Part D prescription drug plan is involved in a situation where their medical expenses are the responsibility or another party through either a settlement, judgement, or other award, the law recognizes that the plan’s responsibility to pay for the beneficiary’s treatment can in certain instances be “secondary.”
However, the process by which the Centers for Medicare & Medicaid Services (CMS) coordinates benefits with settling parties is currently broken when it comes to recoupment of claims related to Medicare Advantage and Part D plans. That’s because, unlike traditional Medicare, settling parties have no way to determine which MA or Part D plan a beneficiary is enrolled in and cannot determine their reimbursement obligations, if there are any. This results in settling parties closing claim files only to find out a year or more later that they may have a reimbursement obligation. For beneficiaries, this could result in a loss of a settlement, and possibly even care delays, as both the settling party and MA or Part D Plans try to reconcile their respective records.
The PAID Act – which was introduced by Senators Scott (R-SC) and Cardin (D-MD) in the Senate and Representatives Ron Kind (D-WI) and Gus Bilirakis (R-FL) in the House – would fix this issue by requiring CMS to share necessary information with settling parties. Through the Section 111 query process, a system that already exists to share information between Medicare and third parties, settling parties would have access to the name of the beneficiary’s plan and the dates of coverage – which is all that is needed to coordinate benefits.
To view the full letter and list of signatories, CLICK HERE.
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When a beneficiary is injured, and another party is supposed to cover their healthcare expenses – such as in a worker’s compensation or liability claim – Medicare’s legal responsibility to pay is “secondary.” Unfortunately, the current Medicare Secondary Payer (MSP) policy is convoluted and confusing, creating problems and inefficiencies for beneficiaries, settling parties and taxpayers alike. That’s why MARC exists: to support commonsense reforms to fix this broken system. MARC's membership represents virtually every sector of the MSP regulated community including attorneys, brokers, insureds, insurers, trade associations, self-insureds and third-party administrators. For more information on MARC, please visit www.MARCcoalition.com.