blackburn group inc.

June 2011

MSPRC ALERT UPDATE: Issuance of Medicare Final Demand Letters Remain Temporarily Suspended - Review of the Rights and Responsibilities Letter Is Complete

As you may have heard from Medicare, review of the Rights and Responsibilities letter ("RAR") is complete. Issuance of the RAR letters resumed on June 10, 2011. The Demand letter for liability insurance (including self insurance), no-fault insurance and workers compensation remain temporarily suspended by Medicare-MSPRC while this letter is under review for Medicare Set Asides. It is important to note that the MSPRC is still working cases, and the demand letters will be mailed out once appropriate revisions have been made. We continue to monitor the situation closely with the Centers for Medicare & Medicaid Services (CMS). In the interim, we are diligently working to keep all cases moving forward.

Recovery Audit Contractor (RAC)

Recently, the U.S. Department of Health and Human Services (HHS) published testimony before the Committee on Homeland Security and Government Affairs Subcommittee on preventing and recovering Medicare payment errors. One of the programs discussed was the Recovery Audit Contractor, which provides the Centers for Medicare and Medicaid Services (CMS) with an important tool for identifying and correcting improper payments each year. The RAC has proven very successful for Medicare resulting in the correction of $1.03 billion in improper Medicare payments. Ninety-six percent of these improper payment corrections – or approximately $990 million – were overpayments collected by CMS from medically unnecessary care or claims that were incorrectly coded. The overall costs of operating the RAC demonstration program have totaled $201.3 million, which is approximately 20 cents for each dollar collected. RACs are charged with obtaining and reviewing health plan information to determine whether Medicare should have been the primary payer overall in a claim, or whether a beneficiary had other coverage such as employer-sponsored coverage or workers compensation insurance that should have made the primary payment. Once the RAC identifies any employer-sponsored coverage or workers compensation insurance program, those organizations are immediately identified as primary payers. The claims are then flagged for future liens by the Medicare Secondary Payer (MSP) process.

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CMS Develops a Medicare Secondary Payer Curriculum

Did you know that CMS has developed a MSP Curriculum that provides general information about Medicare and Medicare Secondary Payer, applicable to Group Health Plans, Non-Group Health Plans-Liability Insurance (Including Self Insurance), No-Fault Insurance, and Workers Compensation? The Curriculum includes the following courses: Introduction to Medicare, MSP Overview, MSP Working Aged, Medicare Secondary Payer Disability and MSP End Stage Renal Disease (ESRD). Once you have registered for the GHP or NGHP curriculum, you will automatically be given access to this curriculum.

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