This post is primarily for trial attorneys and personal injury attorneys.
We at Feroleto Law often get calls from other attorneys on how to deal with insurance claims.
Over the last few years some cases became almost impossible to resolve because Medicare started seeking information and repayment if it made payments for medical care. I agree that repayment is fine, the problem is, it was almost impossible and took many months to see if Medicare was owed anything.
Close to, or at trial, sometimes quick decisions must be made. Those decisions can be the difference between winning and losing a case. If the case is lost, noone gets anything, including medicare, and sometimes health care providers. Trying to get an answer from Medicaid was like trying to get an answer from a brick wall.
Insurance companies and trial attorneys are largely in agreement on passing the SMART Act. Below is a partial summary. CMS refers to the centers for Medicare and Medicaid services.
The SMART Act will:
- · Require CMS to maintain a secure web portal to so one can access reimbursement amounts in a timely manner.
CMS must upload care payments they disperse within 15 days with required information about the payment.
- · Streamline the process of obtaining reimbursement amounts.
Medicare beneficiaries must notify CMS they are anticipating a settlement no more than 120 days before anticipated settlement.
CMS has 65 days to update payments made and put them on the web portal, but may request an additional 30 days, if needed.
Reimbursement amounts are considered reliable if downloaded from the web portal within three days of settlement.
- Provide a process and timeline for discrepancies and appeals.
If you provide documentation for discrepancies on the web portal to CMS, it has 11 days to respond.
If CMS does not respond in 11 days, the amount calculated by the beneficiary is the correct amount.
An additional appeal process will be established by CMS for reimbursements it attempts to collect from insurance plans.
- Create a threshold for collecting 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.
This law will benefit Medicare, those injured by others, insurance carriers and taxpayers. The American Association for Justice played an important part in getting the bill passed.