CMS clarified when it will make payments in the situation where the liability or Worker’s Compensation insurers don’t promptly pay the claims. However, at the same time, Medicare added more “hoops” that you have to jump through in order to qualify for these payments. For instance, If you don’t follow the program’s strict instructions for billing primary insurers, you could face claim denials. Medicare-covered patients who are involved in accidents or injured on the job, then you may find yourself questioning when the federal program benefits apply. Medicare secondary payer (MSP) rules dictate your payment with complicated and often confusing lingo. This means, as a provider, it’s up to you to fully understand the MSP standards and procedures — especially if you expect to receive interim Medicare payments for treating injured patients.
In addition, the Health Reform Act specifies a procedure for providers receiving overpayments. Section 6402 of the PPACA states that Medicare overpayments are to repaid to the government within 60 days of discovery. The law however raises a number of questions which providers hoped would be answered in recent rules issued by CMS. However, clarifications are still needed, and because the law is already effective, providers need guidance in implementing this law. It is critical that overpayments be handled strictly in accordance with the requirements, because failure to do so could result in a fraud claim with possible civil or even criminal penalties.
I am writing today to invite you to join us for this On Demand webinar – “CMS' Guidelines over Secondary Payments and the 60-Day Refund Rule” on Tuesday, 28th May, 2013. This webinar can be accessed anytime on Tuesday.
Key Highlights of the session :
Wayne J. Miller, Esq., is a founding partner of the Compliance Law Group, Los Angeles, a law firm focused on health care industry legal compliance for clients nationwide. Wayne has practiced healthcare business and regulatory law throughout his 30-year career. His firm represents a wide range of healthcare industry clients throughout the nation. He is a frequent speaker for The Coding Institute national teleconferences on healthcare reimbursement, transactional and regulatory...
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