Wednesday, September 25, 2013

Feds block comp attys from seeing medicare data on-line

The Center for Medicare and Medicaid Services has issued new interim rules and provided a period for comment.  Federal Register 78-183 (Sept. 20, 2013).

The SMART Act  provided a web portal to access conditional payment amounts asserted by Medicare.   Finding out the amount of conditional payments and weeding unrelated medical claims has always been a wrench in the works of trying to efficiency resolve state comp claims.  Now people can go on one line and see what is being claimed.   That is, of course, unless the person is an attorney.   Under current regulations, attorneys who represent workers or employers must pre-register but can't access parts of the information because it violates federal rules of privacy.  (FISMA).   CMS in the proposed rules plans to get on that and fix the problem once they "develop a solution" and is sure they'll have something rolled out in January 2016, 3 years after the SMART Act provided access to make the process internet friendly and easy for everyone.   CMS proposes to "develop a solution" a new identify verification for attorneys because apparently attorneys need to be measured twice and cut once. 

Medicare wants plenty of time to let everyone know what it claims as conditional payments and now recommends 6 months in advance notice for anyone planning to settle a case.  Don't even think about settling it on the courthouse steps.    The new proposed rule allows various extensions including new enumerated reasons why Medicare should take longer just in case there is  terrorism, riots or fire beyond the "ordinary" control of government.  This avoids letters from angry citizens wondering why Big Gov is not doing its job when there are riots in the streets.  An attorney disputing any claim for unrelated items can do it "once and only once."  There is no administrative or judicial review of the claims dispute process. 

Attorneys can get a  pro rata reduction in accordance with 42 CFR 411.37 but indicates that new demand letters must obtained if the parties wait more than 30 days to report a settlement. CMS is still trying to figure out how parties can actually report it on line and are working on that too. Cases involving toxic exposure and joint replacement require additional reporting. 

Parties who wish to comment are instructed how to do so electronically, by mail, by overnight mail, or by hand.  Federal regulations prevent someone from delivering it by hand because access to the building is restricted.   The irony of such a statement is probably lost to CMS.