Medicare Reporting Guidelines – 2018 Update

CMS has released its annual SMART Act report to Congress. The report includes the usual updates you’d expect, namely, cost of recovery data and reporting thresholds.

Reporting Thresholds

First, CMS has updated 2018 Mandatory Insurer Reporting and plaintiff-settlement reporting thresholds. Any settlement below these amounts needs not be reported by defendants (or, “primary payers”) and Medicare’s conditional payment amount need not be repaid by plaintiffs. The thresholds are for physical trauma-based injuries:

1. Liability Insurance:                           $750
2. No-Fault Insurance:                          $750
3. Workers’ Compensation:                 $750

These amounts are all unchanged from 2017; however, there were various different amounts in 2016:

1. Liability Insurance (2016 threshold):                        $1,000
2. No-Fault Insurance (2016 threshold):                      $0.00
3. Workers’ Compensation (2016 threshold):              $300

CMS Cost of Collection for Medicare Liens

Second, CMS explains the above reporting thresholds using its cost of collection methodology. Perhaps most interesting is that CMS spent $66,510.786.65 on “benefit coordination and recovery activities.” This number appears to not include MSA review costs. Then, CMS indicates it provided 206,228 Demand letters in 2017. This gives an average cost of collection of $322.51.

Why does this matter?

Because the average Demand amount needs to exceed $322.51 for Medicare Liens to make sense. CMS has provided some very interesting data on settlements and Demand amounts. Take a look here. If you need help with Medicare lien resolution, whether it is the process of resolving Medicare liens or reducing an amount much greater than that $322.51, please contact us at 844.633.5436.