GAO Issues Report Recommending Improvements to the MSP Program

On April 3, 2012, the United States Government Accountability Office (GAO) issued a much-anticipated report examining the Medicare Secondary Payer (MSP) program entitled, “Medicare Secondary Payer: Additional Steps are Needed to Improve Program Effectiveness for Non-Group Health Plans”. The report was in response to a request from Congressman Pete Stark (D-CA), dated August 10, 2010, that the GAO “conduct a detailed examination of issues surrounding Medicare Secondary Payer rules as they apply to Non-Group Health Plans).

The 47-page report found that the Centers for Medicare and Medicaid Services (CMS) workloads increased dramatically during the recent implementation of mandatory insurer reporting. Key challenges were identified related to contractor performance, demand amounts, mandatory insurer reporting, CMS guidance and CMS communication. GAO acknowledged that CMS has addressed many of these issues and in conclusion GAO made the following five recommendations:

  1. Review recovery thresholds to ensure cost-effectiveness of recovery efforts and not require Non-Group Health Plans to report on cases where CMS will have no recovery.
  2. Consider making the reporting of ICD-9 codes optional.
  3. Develop a centralized MSP website.
  4. Issue guidance regarding liability and no-fault Medicare Set-Aside arrangements.
  5. Review and revise correspondence with beneficiaries.

In a letter sent immediately to CMS acting administrator Ms. Marilyn Tavenner, Congressman Pete Stark (D-CA) urged CMS to “quickly take action to implement GAO’s recommendations” and to provide him “with an action plan for implementing these recommendations to further improve the MSP process by May 31, 2012”.


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