Resource Links

MARC Coalition Website H.R. 1063 Bill Text S.B. 1716 Bill Text Support MSP Reform Summary of Reform MSPRC Website CMS MMSEA Website Franco Signor Blog

2011, Issue 1/Week 46 

Clients and Friends of Franco Signor LLC,

Welcome to the inaugural launch of our newsletter on MSP Compliance topics.  We hope you find the information timely and helpful with regard to your MSP Compliance Program. The goal of this electronic publication is to go beyond stating the recent developments of Medicare Secondary Payer Compliance by offering commentary on how it may impact your business.  While this law has been around for over 30 years, its impact to claims operations, involving all lines of business, is a recent occurrence that started when the law was amended in 2007 to include electronic reporting (See MMSEA/Section 111 Reporting).  Since then, the industry has been searching for answers to Medicare Secondary Payer Compliance, but no clear bright lines were being drawn by the Centers for Medicare & Medicaid Services, leaving gaps in compliance and resulting in delays in the processing of claims.

Penalties of $1,000 per day, per claim, is clearly the driving force for the resurgence in Medicare Secondary Payer Compliance.  Although a clear exposure, it pales in comparison to the hidden exposures, which will occur as Medicare collects data on all settlements, judgments, awards and ongoing responsibility for medicals involving Medicare beneficiary claimants.  Changes in closing patterns, from the delays in waiting for Medicare, will have a deleterious effect on reserves.  The claims operation is also exposed to re-opening files to deal with Medicare issues, because they were not properly resolved at the time of claim disposition. This will certainly have an adverse impact with actuaries.

A proactive approach is necessary to mitigate these hidden exposures. Franco Signor LLC can assist with the review and development of a compliance protocol that will provide practical solutions.  A common response we receive when we present to new clients, is how we are able to make sense of what previously was a confusing area.  We can do this because of our risk management, claims and litigation backgrounds, which form the foundation of our company.  Medicare does not need to be an obstacle to the claims process.  However, the technical rules must be followed, otherwise claims will be delayed and additional exposures created.

To kick off our first issue, we feel it appropriate to start with what encouraged us to start this business venture.  The Medicare Advocacy Recovery Coalition (MARC) was started with the simple concept of passing legislation to better align the purpose of the law with claims processes.  While the proposed legislation cannot correct all the issues present in the law, it is a positive step in the right direction and is closer than any other prior attempts by the industry to becoming a reality.  What is needed now is a show of SUPPORT.  As the Senate has now introduced a companion bill (S.B. 1718) to the House bill (H.R. 1063) our time is now to make this a reality.  As Co-Chair for MARC, it is my sincere request that you take a moment, using the links below, and send a letter of support electronically to your House and Senate representative.   

Thank you,

Roy A. Franco