SMART Act may help with Medicare Set-Asides process

Anyone who has applied for government benefits knows that the entire process can be very frustrating and time-consuming. Individuals with serious illnesses or disabilities may be able to apply for Social Security Disability benefits. The application process can take years, and it might be very hard for those who are struggling to make ends meet.

Those individuals who receive Social Security Disability Insurance Benefits may also be eligible to receive Medicare. Medicare pays medical expenses, while the SSD benefits are used to provide an income because they are too injured or sick to work.

Recently, a new law was passed that may have a positive impact upon those that are Medicare beneficiaries. The Strengthening Medicare and Repaying Taxpayers (SMART) Act, will streamline the process that requires reimbursement to Medicare for medical expenses that are arguably the responsibility of third parties, such as workers’ compensation insurance carriers, employers or automobile and liability insurance carriers. This improved process was enacted in response to complaints by injured workers, employers and insurance carriers that the Center for Medicare and Medicaid Services (CMS) was delaying and frustrating the process of trying to resolve disputed claims for workers’ compensation benefits and automobile accident claims.

Individuals that are injured in a motor vehicle accident or workplace accident are required to ensure that Medicare is reimbursed for any expenses that should be covered by other parties. This is known as the Medicare Secondary Payor Recovery Act. Contractors hired by the government collect the money but have been roundly criticized for being slow and oftentimes inaccurate in identifying payments to be reimbursed. In the past, it was difficult to determine the amount that was to be repaid. The Medicare system often made it very challenging for individuals to receive their settlements, which could result in a lengthy delay before funds were released.

The new law attempts to streamline this process so that individuals know exactly what they will be required to repay while their case is ongoing. As part of the SMART Act, the Medicare Secondary Payor (MSP) system will be made easier to navigate. The Centers for Medicare and Medicaid Services (CMS) will set up a Website that will allow those who have been injured to contact the agency within 120 days of a potential settlement.

The CMS will then have 65 days to make sure their information is current, but may receive another month if needed. The CMS will then determine settlement amounts, which will be considered as correct if accessed within three days of the actual settlement.

The new portal will also make it easier for those who have been injured to contest the findings made by the CMS. The injured party has 11 days to notify the CMS of any errors, and the agency must respond in 11 days to the issue at question. If the agency does not respond during that 11 day period, the amounts submitted by the individual are used.

This should make things much easier for those who rely upon these benefits, but it remains to be seen if the system will work as designed. If you have questions about this system, contact an attorney experienced with workers compensation, social security disability and personal injury Medicare issues to learn more about what you can do to help you receive the compensation you need to cover medical expenses.