government
Contractors recoup billions under Medicare secondary payer program
Posted April 16, 2012
The Medicare program saves nearly $1 billion a year through a strengthened secondary payer enforcement program, according to a Government Accountability Office report released in April.
Medicare is not the primary payer for physician claims when beneficiaries are injured at work or in automobile crashes. In 2007, Congress required nongroup health plans, such as liability insurers or workers’ compensation plans, to notify the Centers for Medicare & Medicaid Services of these incidents. CMS then would attempt to identify Medicare payments for beneficiary care and recover any overpayments when Medicare should not have been the primary payer.
Mandatory reporting has been phased in gradually. The workload for three contractors administering the program has increased steadily to more than 900,000 claims investigations and other activities in 2011, up from just over 400,000 in 2008, the GAO said. Total savings also has increased to $861.7 million in 2011 from $737.3 million in 2008.
“The total impact of mandatory reporting on Medicare savings could take years to determine for various reasons, including that mandatory reporting is still being phased in,” the GAO said. Also, the payoffs are not always immediate, because some investigations and recoveries take more than a year to complete.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/04/16/gvbf0416.htm.
