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Proposed Implementation Fails to Reduce Payment Processing Time

NEW YORK (November 18, 2013)—RIMS, the risk management society™, has expressed its disappointment with the Centers for Medicare and Medicaid Services (CMS) for its decision to issue an Interim Final Rule (IFR). The added rule would allow for more than double the statutory 120-day period to obtain final payment amount on Medicare and Medicaid settlements.

RIMS position was expressed in an open letter to The Honorable Marilyn Tavenner, Administrator for the CMS, Office of the Department of Health and Human Services. In it, RIMS President John Phelps states:

“We urge the CMS to rescind its IFR and to re-issue a new proposed rule through the regular comment process.”

Phelps continues, “In addition to conforming to the requirements of the SMART Act, the CMS proposal also must work within the context of how settlements actually occur, and should promote, rather than delay the settlement of claims…The potential that settling parties would have to wait over half a year to conclude their settlement because of a lengthy MSP process will lead many settlements to breakdown.”

In addition to the proposed extension of the settlement timetable, RIMS also objects to the CMS’ decision to use an IFR rather than the regular notice and comment process, as well as the new regulation’s preservation of the CMS’ right to future medical claim recoveries. 

As authorized in January, the SMART Act is a bipartisan legislation that streamlines the reporting process for insurers, self-insurers and nongroup health insurers, who are secondary payers, where there is a settlement with a Medicare beneficiary.

RIMS will continue to monitor the progress of this IFR and the implementation of the SMART ACT, as well as other key legislation that impact the risk management profession.  For more information about RIMS External Affairs initiatives, visit www.RIMS.org/externalaffairs.