The SMART Act requires the Centers for Medicare & Medicaid Services (CMS) to review its costs related to recovering conditional payments compared to recovery amounts annually.
After their analysis, CMS announced the reporting thresholds for Liability, No-Fault and Workers Compensation claims for 2019.
CMS calculated a threshold for physical trauma-based liability insurance settlements. “Effective January 1, 2019, CMS will maintain a single threshold for these cases, where settlements of $750 or less do not need to be reported and Medicare’s conditional payment amount related to these cases did not need to be repaid.” CMS will also maintain the current $750 threshold for workers’ compensation settlements.
The threshold will remain at $750 for no-fault settlements where the no-fault insurer does not otherwise have ongoing responsibility for medicals (ORM.) “Accordingly, settlements of $750 or less for no-fault insurance and workers’ compensation will not need to be reported and Medicare’s conditional payment amount related to these cases will not need to be repaid.”
The CMS alert can be read here – here
If you have questions about Mandatory Insurer Reporting, Medicare Secondary Payer requirements, thresholds, or Conditional Payment Resolution, feel free to contact Flagship Services Group.