On February 27, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing provisions of the Strengthening Medicare and Repaying Taxpayers Act (SMART Act), establishing a right of appeal and formal Medicare Secondary Payer (MSP) appeals process for applicable plans for situations where the Secretary seeks to recover payments from applicable plans. Applicable plans include liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans. The SMART Act further requires that the Medicare beneficiary who received the items and/or services in question be notified of the applicable plan’s intent to appeal.
Unlike Medicare beneficiaries prior to this regulation, recovery demands issued to the applicable plan as the identified debtor had no formal administrative appeal rights or judicial review. The agency’s recovery contractor addressed any dispute raised by the applicable plan but there was no multi-level formal appeal process for applicable plans. Now applicable plans will have the same appeal rights as beneficiaries, including a formal administrative appeal and judicial review rights. The Final Rule will be effective Tuesday, April 28, 2015.
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