Medicare Reform Update: Congress Approves SMART Revisions

Medicare Reform Update: Congress Approves SMART Revisions | Pintas & Mullins Law Firm

Personal injury attorneys are pleased to announce that Congress passed a major bill that will pay off for Medicare beneficiaries nationwide. The Strengthening Medicare and Repaying Taxpayers Act (SMART) bill will better safeguard beneficiaries’ sensitive personal information, help avoid needless litigation and provide for speedier settlements.

The SMART Act was initially brought before the House of Representatives in March of 2011 and the Senate in October of 2011. In addition to strong bipartisan support in Washington, industry stakeholders have also garnered their support for the bill. In simple terms, anyone who resolves a case involving a Medicare beneficiary must reimburse Medicare for the benefits that it paid. Before this bill passed, beneficiaries and settling parties had no way to determine the amount of reimbursement money owed to Medicare until the claim settled. This led to a number of problems, and delayed settlements almost indefinitely until the parties figured out the correct payment amount.

Furthermore, settlements were often based on estimated figures that later turned out to be inaccurate. The SMART Act changed all of this, allowing the parties to determine the conditional payment amount before the claim is settled. It also simplifies the legal process and helps Medicare beneficiaries avoid significant hurdles.

These modifications are partly due to the increased scrutiny of Medicare Secondary Payer (MSP) issues in the wake of Obama’s healthcare reform. The Act clarifies the statute of limitations period to file an MSP claim, allowing three years to a file a complaint. It also helps protect sensitive information of beneficiaries and prevent Medicare fraud, by requiring alternate means to identify them beyond social security numbers and Medicare claim numbers.

Any parties that ignore Medicare’s reimbursement right may face a direct action by Medicare to recover its payment. This includes beneficiaries, physicians, attorneys, state agencies, private insurers, and anyone else who received a primary payment in the case. If this payment is not received within 60 days, Medicare can actually seek to obtain double the amount of benefits that it paid.

The SMART Act also allows for consideration of legitimate defenses and mitigating factors that could delay an MSP claim. It further requires that penalties are based on intentional, willful violations.

Among the SMART revisions includes the claimant’s ability to notify Medicare that a payment is reasonably expected, and request a statement of the reimbursement amount for any payments starting 120 days before the expected date of settlement. Medicare must then respond to this request within 65 days with a reimbursement statement or prescribed procedures for the claimant to follow if a statement is not received. 

The SMART Act is in no small part the result of efforts made by the Medicare Advocacy Recovery Coalition (MARC), a national industry group aimed at resolving MSP compliance issues. The revisions will enable beneficiaries to more efficiently file claims, receive settlements, and understand the MSP reimbursement process. The realm of Medicare and MSP regulations is extraordinarily complex, and those suffering from injuries or illnesses should not have the added anxiety of unclear government mandates preventing them from receiving justice.

Personal injury attorneys at Pintas & Mullins Law Firm remind those affected by this bill that revisions may be made to the bill at any point in the legislative process. As the bill stands now, it will resolve many of the practical problems underlying the current Medicare reimbursement process. Our experienced team of Medicare lawyers will continue to help beneficiaries pursue their claims and obtain the settlements they deserve.