News

PAID Act Would Help Pools Resolve Medicare Secondary Payer Claims

  

The Provide Accurate Information Directly (PAID) Act (S.1989/H.R.1375) is a bill that would help settling parties (e.g., pools) promptly reimburse injury claims for Medicare beneficiaries covered by a privately administered Medicare Advantage (MA) or Medicare Part D plan.

When a Medicare beneficiary is injured by another entity, Medicare Secondary Payer (MSP) obligates the liable entity’s insurance provider to pay for the resultant expenses. Though Medicare may initially bear these costs, Medicare is entitled to seek reimbursement from the liable party’s insurer, which may be a public entity risk pool.

This reimbursement obligation becomes complicated when the beneficiary is covered by a private-sector MA or Part D plan. Unlike with normal Medicare coverage, the responsible party’s insurer or pool may not have details or contact information about the beneficiary’s MA or Part D plan – or even know such additional coverage exists. 

As a result, pools may not always fully understand their reimbursement obligations to an injured beneficiary’s MA or Part D plan. In some cases, failure to reimburse (even without the necessary information to do so) could lead to lawsuits and double damages against insurers or pools.

The Centers for Medicare & Medicaid Services (CMS) does have MA and Part D information and could share it with settling parties. Currently, it does not, which prevents the timely resolution of MSP claims.

According to the Medicare Advocacy Recovery Coalition (MARC), the PAID Act would fix this by simply requiring CMS to share beneficiary MA or Part D information with pools and insurers through existing data transfer mechanisms.



More information on the PAID Act is available via the MARC website.

Permalink