Final CMS Rule Implements Medicare Secondary Payer Law

The CMS released a final rule requiring a right of appeal and an appeal process for liability insurance, no-fault insurance and workers’ compensation laws or plans when Medicare pursues a secondary payer recovery claim directly from an insurer.

The rule (CMS-6055-F; RIN 0938-AS03) issued Feb. 26 implements the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), which became law in 2013. It is scheduled to appear in the Feb. 27 Federal Register and takes effect April 28.

The rule will provide a formal administrative appeal process for Medicare Secondary Payer recovery claims where the applicable plan is ...