Back in January 2013, President Barack Obama signed the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2011. It is anticipated that the SMART Act will reduce Medicare spending by some $45 million over the next 10 years by streamlining the process. But how?
The SMART Act modifies Medicare Secondary Payer (MSP) rules, these modifications are expected to lead to more cost-effective and efficient resolutions of claims and are designed to streamline or bypass rules that previously delayed or prevented effective settlements.
According to the American Association for Justice (AAJ) The SMART Act will:
Require CMS to maintain a secure web portal to access claims and reimbursement amounts in a timely fashion.
CMS must upload care payments they disperse within 15 days with the required information about the payment.
The portal must provide supplier or provider names, diagnosis codes, dates of service, and Conditional Payment amounts.
The portal must accurately identify that a claim or payment is related to a potential settlement, judgment, or award.
The portal must provide a method for receipt of secure electronic communications from the beneficiary, counsel, or the applicable plan.
Information transmitted from the portal must include an official time and date of transmission.
The portal must allow parties to download a statement of reimbursement amounts.
Streamline the process of obtaining reimbursement amounts.
Medicare beneficiaries must notify CMS they are anticipating a settlement no more than 120 days beforehand.
CMS then has 65 days to ensure the web portal is up-to-date, but may request an additional 30 days, if needed.
Reimbursement amounts are reliable if downloaded from the web portal within three days of settlement.
Provide a process and timeline for discrepancies and appeals.
Medicare beneficiaries can provide documentation for discrepancies on the web portal to CMS.
CMS has 11 days to respond to discrepancies.
If CMS does not respond in 11 days, the amount calculated by the beneficiary is the correct amount.
An additional appeal process must be established by CMS for reimbursements it attempts to collect from insurance plans.
Create a threshold for collecting any payment amounts by CMS that are below the cost it incurs to collect an average claim.
Readjust the penalty for reporting errors by insurers based on the violation.
Ensure greater privacy for beneficiaries by no longer requiring use of full social security or health id claim numbers.
Create a three-year limit for CMS to seek any repayments beginning from when they were informed of an anticipated settlement.
If you’d like more information on the SMART Act as it relates to your Worker’s Compensation case and the MSP rules, contact an attorney at Meshbesher and Spence today.