Medicare Subrogation. a.k.a. - Medicare Secondary Payer Liability and No-Fault Public Information Available at No Charge Sally Stalcup Region 6 MSP Regional Coordinator. The History of MSP. 7/1/66 Medicare Worker’s Comp, VA, Black Lung, Federal Programs
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
a.k.a. -MedicareSecondaryPayer Liability and No-Fault
Public Information Available at No Charge
MSP Regional Coordinator
Includes, but not limited to: automobile liability, uninsured, underinsured; PIP/Med-pay; homeowners; wrongful death; malpractice; product liability including self insured plans 42 CFR 411.50
Federal Tort Claims Act
See 42 C.F.R.§411 et al.The Basics: What we do
Administration Services, LLC (CNI)
Effective October 2, 2006, The Centers for Medicare & Medicaid Services (CMS) awarded a contract for one national Medicare Secondary Payer Recovery Contractor (MSPRC) to: Chickasaw Nation Industries, Inc. – Administration Services, LLC (CNI).
The MSPRC has responsibility for all MSP recovery cases with three exceptions:
(2) demand letters issued by the MSP Recovery Audit Contractors (RACs) implemented as a demonstration under the Medicare Modernization Act of 2003 and. The RACs will continue to have responsibility for certain MSP GHP based recovery demands for the States of California, Florida, and New York and
(3) TrailBlazer Health Enterprise, LLC, (along withEmpire – Syracuse NY or Harrisburg PA, First Coast Service Options – Jacksonville FL, Mutual of Omaha – Omaha NE, and Palmetto – Augusta GA or Columbia SC or Columbus OH) retained any case for which they had already issued a formal demand for payment.
7500Security Blvd, Mail Stop C3-13-00
Baltimore, Maryland 21244-1850
Medicare creates a file and verifies the Privacy Release
Medicare identifies related claims and sends notice
Beneficiary and attorney review claims
Settlement data added
Medicare calculates procurement reduction (42 CFR 411.37) & issues demand letter
Payment to Medicare within 60 daysMedicare’s Recovery Process:Case Assigned to MSPRC
#1 Is the claim “related to” the incident?
-- If yes, then Medicare recovers
-- If no, ask question #2
#2 Was claim used to procure settlement?
-- If yes, then Medicare recovers
-- If no, then Medicare does not recover
**An appeal may only be requested by an entity deemed “party to an appeal”
1. Financial Hardship
2. Equity & Good Conscience
Federal Claims Collection Act – handled by CMS Regional Offices
-- The beneficiary
-- A surviving spouse or dependent
who is entitled to either :
a) Social Security Disability Insurance Payments (Title II)
42 CFR §411.24(h)
Consider the impact of interest on decision to pursue a waiver or compromise.
Suspect Medicare’s Involvement
If the Medicare beneficiary is enrolled in either you should contact that plan apart from your notice to COBC to determine their recovery interest.
Medicare - COB
MSP Claims Investigation Project
P.O. Box 5041
New York, NY 10274-0125
voice (800) 999-1118
fax (646) 458-6760 or 6762
Detroit, MI 48232-3828
P. O. Box 33828 (866) MSP-RC20 (866) 677-7220
P. O. Box 33831
Detroit, MI 48232-3831
P. O. Box 33829
Detroit, MI 48232-3829
Sally Stalcup (214) 767-6415
Lindsey Kittrell (214) 767-4418