CMS Issues Memo on MSP Obligations When Settling Alleged Exposure Claims

by B. Smith

On January 20, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a memo entitled Medicare Secondary Payer (MSP) Obligations and Settlements Related to Alleged Exposure to Roundup. The memo focuses on conditional lien repayment and recovery options for Medicare beneficiaries who are settling medical claims allegedly caused by exposure to Roundup.

The memo also provides a nice overview of the Medicare Secondary Payer recovery process options noting that claimants may resolve Medicare’s recovery interest in one of two ways. The first is by the standard recovery process through the Benefits of Coordination and Recovery Center (BCRC). The BCRC calculates recovery for Parts A and B liens after reviewing claims related to the injury being claimed, released, or released in effect. Medicare may also compromise or waive its recovery right on a case-by-case basis. This is the most traditional and commonly used route for Medicare beneficiaries.

The second option is when Medicare is reimbursed by determining the full value of an MSP “global” recovery claim for a large group of beneficiaries that is paid through an entity or lien resolution company. Upon settlement, the full recovery amount is allocated among the beneficiaries and a portion of the settlement proceeds are withheld to satisfy Medicare’s interest. Exposure claims, such as the Roundup claim, frequently use the global resolutions process.

In the memo CMS also answered questions for beneficiaries involved in this litigation including how to either opt in or remove themselves from the global process. CMS also noted timeframes for lien resolution.

Although this memo involves a specific exposure case, it illustrates the continued need to not only resolve traditional Medicare liens, but also to identify the best process to expedite resolution. Working with a conditional lien specialist helps ensure that the right steps are taken at the right time to prevent potential damages, fees, and unanticipated costs. In addition, your MSP compliance partner should be able to help guide you in all aspects of settlement including:

• • • Medicare Advantage
    • Part D (prescription drug)
    • Medicaid
    • Third party/other lien resolution
    • Future medical allocations
    • Post-settlement administration
    • Structures
    • MSP mediation support
    • Claim triage
    • Section 111 obligations

IMPAXX is an MSP compliance solutions provider that can assist with every aspect of your MSP compliance obligations. If you are in the process of resolving a claim, want to review your MSP obligations before settlement, or would like to establish a Medicare compliance protocol, please contact the IMPAXX Settlement Consultant team at [email protected].