Highlights from CMS’ Second PAID Act Webinar
Last week on August 9, 2021, the Centers for Medicare and Medicaid Services (CMS) hosted its second Provide Accurate Information Directly (PAID) Act webinar. The second webinar naturally followed CMS’ original June 23, 2021 PAID Act webinar, which provided an overview of the PAID Act and upcoming changes.
This second PAID Act webinar was more narrowly tailored to CMS providing information on the upcoming testing period (begins September 13, 2021) and the technical aspects of the new HIPAA Eligibility Wrapper (HEW, version 5.0 or HEW v5.0).
Below are a few key takeaways:
· The testing period begins on September 13, 2021 and ends December 10, 2021
· Version 5.0 of the HEW application (HEW v5.0) becomes available on September 13, 2021
· HEW v5.0 is for testing purposes only until December 10, 2021
· A test beneficiary list and sample query response file are now available for download in anticipation of the testing period
· For technical questions regarding testing, Responsible Reporting Entities (RREs) must contact their assigned Electronic Data Interchange (EDI) representative.
Noteworthy Questions and Answers:
Q: RREs will now receive Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Drug Plan) information. What are RREs required to do with this new information?
A: The PAID Act, in and of itself, does not require any action by RREs. It is up to each individual RRE to decide how to use the Part C and D plan information in coordinating benefits. CMS will not comment on any potential reporting penalties as it relates to the PAID Act changes.
Q: Will the HEW v5.0 interfere with the current version of the HEW software?
A: No; RREs may run both versions of the HEW software without disrupting current reporting production.
Q: RREs are not required to use HEW v5.0. As such, will CMS provide an unwrapped test file (during the testing period) to allow non-HEW v5.0 users to ensure that their reporting codes translate properly?
A: An answer is not currently available.
Q: Will there be continued technical support for the current version of the HEW software (HEW v4.0)?
A: Unknown; however, technical support for the current version of the HEW software will likely end when the next HEW update occurs.
Q: Does CMS have any plans to display an individual’s Part C and D plan information on the Medicare Secondary Payer Recovery Portal?
A: No; the CMS recovery process is separate and distinct from the Section 111 reporting process.
Commentary:
Since its first PAID Act webinar in June, CMS has maintained a firm stance that the PAID Act does not impose any affirmative obligations on RREs to contact and/or resolve conditional payments with Part C or D plans. However, given the current litigation landscape (ripe with aggressive Part C plans filing lawsuits to recover medical payments from RREs), we recommend that RREs use the PAID Act changes to proactively communicate with Part C and D plans to resolve conditional payment disputes.
If the Part C and D plan conditional payments are not resolved pre-settlement, RREs may receive conditional payment demands from the Part C or D plan post-settlement. Further, entities such as MSP Recovery LLC are filing double damages lawsuits on behalf of Medicare Advantage Plans against primary payers with the allegation that the primary payer failed to resolve Part C and D conditional payments. Thus, the benefit of reaching out to known Part C and D plans pre-settlement is to avoid post-settlement conditional payment demands and/or double damages lawsuits.
We further recommend that RREs take full advantage of the new HEW v5.0 software, participate in the testing period, and develop a PAID Act plan in anticipation of the December 11, 2021 PAID Act “go-live” date. Workers’ compensation, general liability, and no-fault RREs should develop a PAID Act plan in conjunction with existing MSP Best Practices that anticipates what action the RRE will take, if any, in response to notification in the query response file that the injured party has or had enrollment in a Part C or D plan(s). Because Medicare beneficiaries can change Medicare plans annually, CMS is planning to provide in the query response file the last 3 years, up to 12 instances, of Part C and D plans that a Medicare beneficiary has been enrolled in.
Thus, at the time of settlement, it is possible that on a single claim an RRE may need to resolve conditional payments with traditional Medicare (if the claimant ever had Part A or B coverage), Medicare Part C, as well as Medicare Part D. Your PAID Act plan should anticipate these multiple conditional payment inquiries which may occur in the settlement of a claim.
Further, RREs should be prepared as there are over 8,000 Medicare Advantage Plans across the country, smaller/regional Part C and D plans may be inundated with newfound call/dispute volume. Larger Medicare Advantage Plans like Humana or Aetna will likely be ready for the increased volume of calls to their subrogation departments, but smaller/regional Part C or D plans may not. Medicare should never hold up a good settlement. How long should your adjusters wait to hear back after reaching out to a Part C or D plan that is non-responsive? All of these factors, and then some should be considered with regard to the impact of the PAID Act on settlement timelines.
Sanderson Firm is available to discuss your company’s Best Practices in conjunction with the PAID Act, which is just a few months away. If you have any questions regarding the webinar, or would like guidance regarding the PAID Act, please contact us.
