Medicare Denies Coverage for Certain Injuries after Insurers begin Reporting

Reports of denied benefits significantly increased after Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA Section 111) was implemented.  After research several of this denials, it is apparent most of them are due to provider’s misunderstanding of the Medicare Secondary Payer laws.  During a conversation with Centers for Medicare and Medicaid Services (CMS), we learned that CMS was in the process of developing guidance to providers to help them understand their obligations under Medicare Secondary Payer and their options when a claim is denied.  We suggested they post that guidance so insurers and third party processors that have been bearing the brunt of these problems, could read and forward that information to their insured and / or their providers.  CMS announced they had posted the guidance on the COBSC in the April 2012 teleconference.  You can find a copy HERE