CMS Interim Final Rule on Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal
December 11, 2013 | Strategic Insights for Health System
The Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act) enacted on January 10, 2013, requires the Centers for Medicare and Medicaid Services (CMS) to establish a web portal through which Medicare beneficiaries, their attorneys or other representatives, and authorized applicable plans that have pending liability insurance (including self-insurance), no-fault insurance, or workers' compensation settlements, judgments, awards, or other payments, may access Medicare secondary payer (MSP) conditional payment amounts and claims details. CMS published an interim final rule on September 20, 2013, which went into effect on November 19, 2013, after a brief comment period. The rule was enacted to implement the expansion of the existing MSP web portal as required for compliance with the SMART Act. The MSP web portal permits authorized users and applicable plans to register in order to access MSP conditional payment amounts electronically and update certain case-specific information online. Upgrades to the web portal, as provided in the interim final rule, permit users to notify CMS that the specified case is approaching settlement, obtain time- and date-stamped final conditional payment summary forms and amounts before reaching settlement, and ensure that relatedness disputes and any other discrepancies are addressed within 11 business days of receipt of dispute documentation.