Source: https://www.natlawreview.com/article/medicare-secondary-payer-compliance-introduction-part-i
Timestamp: 2019-04-22 02:56:33+00:00

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This post is the first in a series from Epstein Becker Green on the growing area of enforcement of the Medicare Secondary Payer Act (MSP). There has been a recent growth in enforcement actions and regulatory interest that may not have yet attracted the attention of many providers and traditional and non-traditional payers. Noncompliance with the MSP can result in monetary penalties and government enforcement action. In particular, the MSP is garnering attention as an enforcement tool under the False Claims Act (FCA). This series of blogs provides a general overview of the MSP, discusses requirements for compliance for differing entities, describes recent MSP enforcement actions under the False Claims Act (FCA), and sets forth key takeaways to potentially reduce liability.
(3) permits CMS to make “conditional payments” to the beneficiary if there is a delay in reimbursement from another entity for a covered service.
Congress also enacted a parallel MSP provision that applies to state Medicaid plans.
A beneficiary is entitled to Medicare on the basis of disability, but is covered under a GHP by virtue of his or her current employment status or the current employment status of a family member.
IRS/SSA/CMS Claims Data Match – By law, the IRS, Social Security Administration (SSA) and CMS must share information regarding beneficiaries. Employers must complete the IRS/SSA/CMS Claims Data Match questionnaire for each GHP that Medicare eligible beneficiaries and their spouses choose.
Voluntary Data Sharing Agreements (VDSAs) – These agreements allow employers and CMS to exchange GHP enrollment information.
COB Agreement (COBA) Program – This program established a national standard contract between the BCRC and other health insurance organizations for the purpose of transmitting beneficiary eligibility data and Medicare paid claims data.
Section 111 Required Reporting Requirements – Under this law, GHPs, workers’ compensation, self-insurance, and no-fault insurance (collectively, non-group health plans, or NGHPs) must register as a Responsible Reporting Entity (RRE) and report certain information pertaining to each enrollee’s Medicare eligibility, as discussed in more detail below.
Other Data Exchanges – CMS has created data exchanges with other entities, such as Pharmaceutical Benefit Managers, State Pharmaceutical Assistance Programs, and other prescription drug payers for the purpose of educating these entities regarding COB processes and the MSP framework.
Through these databases, the COB coordinates efforts between CMS, primary payers, and providers to ensure that Medicare is billed properly.
This wide variety of reporting sources may be daunting for many providers and payers who are required to report. However, these fears can be overcome by incorporating these tasks into the organization’s existing compliance program if the requirements for reporting are known. In the next blog post, we will be addressing compliance with conditional payment requirements provided by Medicare.
This is part 1 of 7 in the Medicare Secondary Payer Compliance series.
 42 USC § 1395y(b)(2)(A)(i); 42 CFR § 411.20.
 42 USC § 1395y(b)(2)(A)(ii); 42 CFR § 411.20.
 42 USC § 1395y(b)(2)(B); 42 CFR §§ 411.21 & 411.24.
 42 USC § 1396a(a)(25); 42 CFR §§ 433.135-140.
 42 USC § 1395y(b)(1); 26 USC § 5000(b)(1).

References: § 1395
 § 411
 § 1395
 § 411
 § 1395
 § 1396
 § 1395
 § 5000