The Centers for Medicare and Medicaid Services (CMS) now has a formal appeals process for liability insurance (including self-insurance), no-fault insurance and workers’ compensation plans. It became active April 28, 2015, and applies to demand letters issued on or after that date. The process reiterates CMS’ authority to recover directly from applicable plans regardless of earlier attempts from the beneficiary or provider.
New documents have been released that outline the appeals process, including a notice that must be issued to Medicare Beneficiaries and others covered under the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).
View the new documents released:
- Appeals Process for Insurers and Workers’ Compensation Entities & Notice Required To Be Issued To Medicare Beneficiaries
- Appeal Rights for Applicable Plans
The Centers will continue to monitor any additional updates related to CMS, the SMART Act and the new appeals process. Should you have any questions about how this could affect your practice or your clients, please contact us online here or call (877) 766-5331.
Please find the entire text of the SMART Act; 80 FR 10611 here. This information is not intended to take the place of legal advice on any particular matter. Consult with your lawyer and tax advisor for any specific questions regarding these changes.