WASHINGTON, DC – The Medicare Advocacy Recovery Coalition (MARC) today commended Senators Tim Scott (R-SC) and Ben Cardin (D-MD) for introducing the Provide Accurate Information Directly Act (PAID Act) (S. 1989), a bipartisan bill to improve the Medicare Secondary Payer process and provide a clear framework to enable the smoother coordination of benefits between settling parties and private Medicare plans. A companion bill (H.R. 1375) sponsored by Representatives Ron Kind (D-WI) and Gus Bilirakis (R-FL) was introduced in the House of Representatives in February.
“We applaud Senators Scott and Cardin for working together on a bipartisan solution to fix the broken Medicare Secondary Payer process,” said Re Knack, Chair of MARC, DRI Member and Chair Emeritus for DRI’s MSP Task Force. “The PAID Act will establish a clear process for sharing information between settling parties and private Medicare plans to ensure claims can be resolved promptly and beneficiaries can receive what they are owed.”
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 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 fixes this issue by requiring CMS to share necessary information with settling parties - namely the names of the plans and the dates of coverage - through the section 111 query process, a system that already exists to share information between Medicare and third parties.
“We need Congress to act now to create a more efficient solution for beneficiaries, taxpayers, and employers,” Knack concluded. “The PAID Act is a bipartisan solution that’s a win-win-win for everyone. We truly appreciate Senator Scott and Senator Cardin for their leadership on this common sense legislation that will improve the lives of millions of Medicare beneficiaries in South Carolina, Maryland and across the country.”
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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 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.