NU Online News Service, July 5, 2:54 p.m. EDT

WASHINGTON—Property and casualty insurers want federal regulators to re-examine rules allowing Medicare to be reimbursed for medical claims that are at least partially covered by private-insurance coverage such as workers' compensation and auto.

In a letter to the Department of Health and Human Services, 34 insurers ask the agency to re-examine what it calls the burdensome regulations imposed on non-group health plans through regulations stemming from a 2007 law.

The letter says these non-group health plans "have been striving to prepare for and adhere to what can only be described as burdensome, incorrect and unclear guidance created by the Office of Financial Management within the Centers of Medicare and Medicaid Services."

The regulations were imposed by CMS to implement the Medicare Secondary Payer Act (MSP) provision of a 2007 law.

The law is a reporting mandate designed to ensure that Medicare remains the secondary payer when a Medicare beneficiary has medical expenses that fall under the primary responsibility of a liability, no-fault or workers' comp insurance plan (including those that are self-insured).

It also will allow Medicare to recover any conditional payments it has made that should have been paid by the primary insurance plan.

The insurers want HHS to re-examine the regulation as part of a mandate imposed on all federal agencies in January by President Obama to re-examine rules that impose burdensome regulations on the industry.

Insurers are concerned because HHS has not included examination of the MSP provision in its "Preliminary Plan for Retrospective Review of Existing Regulations."

The letter was signed by Peter R. Foley, vice president-claims administration, for the American Insurance Association (AIA).

The AIA is coordinating a coalition of 34 foreign and domestic insurance groups and foreign trade associations in an effort to challenge what it calls the burden of reporting and to "educate CMS as it deals with the [P&C] industry for the first time."

The coalition is called the AIA Section 111 Task Force. In addition to AIA and its members, it includes ACE, Allstate and Lloyds of America. Foreign members include CEA (the European insurance and reinsurance federation) based in Brussels and Insurance Bureau of Canada (IBC).

The letter says, "CMS's basic lack of knowledge and understanding of the [P&C] insurance industry has plagued implementation of the MSP law reporting from the beginning."

It adds that CMS has attempted to institute an entirely new reporting scheme in a subregulatory environment while "on the fly."

According to the letter, "Information remains confusing and difficult to understand since CMS adheres to its own definitions rather than those of the industry."

Special Reports /

Insurance Coalition Challenges CMS on Medicare Second Payer Reg

Related Stories

Recommended For You