Coalition Formed For Secondary Payer Issue

A coalition that includes insurance companies has been formed to negotiate with the Medicare program as well as Congress on overhauling reimbursement and recovery procedures for secondary payers.

The coalition, being called the Medicare Advocacy Recovery Coalition, is being created as Medicare is launching a “new, and potentially massive, program involving liability claims,” according to co-chairman Roy Franco, who also serves as director of risk management strategies for Safeway.

“We look forward to working with the Center for Medicare and Medicaid services as they” initiate this program, he said.

The other chairperson is Katie Fox, who also serves as the manager of the Medicare Secondary Payer Compliance and Resolution Unit for MedInsights, Inc. a GAB Robins company.

"Our goal is to make it easier for Medicare beneficiaries to settle claims and ensure that they receive uninterrupted Medicare payments for claims,” Mr. Franco said.

Problems with the system have arisen for injured workers receiving workers’ compensation payments who become Medicare eligible. Difficulties arise because of Medicare system blocks to ensure Medicare does not begin paying for care until the comp settlement runs out, which is usually done through a set-aside trust.

The coalition includes major employers, insurance companies, third party administrators and lawyers.

"We as an industry need to ensure beneficiaries receive seamless coverage," Ms. Fox said. "We already have a base of support and look forward to working with the Congress and CMS in partnership."

The objectives of the coalition include ensuring that Medicare beneficiaries receive coordinated and uninterrupted coverage for claims involving secondary payer issues; and to provide coordination, collaboration and communication among the member organizations regarding Medicare reimbursement and recovery policy.

They will also work to develop and implement a legislative and regulatory strategy designed to enhance Medicare reimbursement and ensure that the secondary payer program “works effectively, efficiently and economically,” Mr. Franco and Ms. Fox said.

Its insurance members include Colorado Self Insurers; Crowe Paradis Services Corp.; Gallagher Bassett Services Inc.; and Liberty Mutual Group.