Synergy Blog

SMART ACT APPEALS FOR PLANS

SMART ACT APPEALS FOR PLANS

By: Dave Place, J.D., Vice President, Director of Lien Resolution Services, Synergy Settlement Services

On February 27, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing provisions of the Strengthening Medicare and Repaying Taxpayers Act (SMART Act), establishing a right of appeal and formal Medicare Secondary Payer (MSP) appeals process for applicable plans for situations where the Secretary seeks to recover payments from applicable plans. Applicable plans include liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans. The SMART Act further requires that the Medicare beneficiary who received the items and/or services in question be notified of the applicable plan’s intent to appeal.

Unlike Medicare beneficiaries prior to this regulation, recovery demands issued to the applicable plan as the identified debtor had no formal administrative appeal rights or judicial review. The agency’s recovery contractor addressed any dispute raised by the applicable plan but there was no multi-level formal appeal process for applicable plans. Now applicable plans will have the same appeal rights as beneficiaries, including a formal administrative appeal and judicial review rights. The Final Rule will be effective Tuesday, April 28, 2015.

To learn more, please contact us at 877-242-0022 or visit www.synergysettlements.com.

TESTIMONIALS

"I just wanted to say thanks to you and the entire Synergy Settlement Services team for helping us put together a series of structured settlements and special needs trusts in two complex cases involving significant recoveries. As always, your accessibility, guidance and expertise on a whole host of post-settlement issues is very much appreciated and valued, particularly with respect to the often confusing topic of Medicare set asides. I look forward to our continued collaboration on cases in the future and am very appreciate of the first rate service your company continues to provide to our clients."

Stephan Le Clainche
Formerly of Babbitt, Johnson, Osborne & Le Clainche

When we face difficult post resolution issues, we turn to Synergy. They provide us with the necessary expert advice about Medicare compliance, preservation of public benefits, lien resolution and settlement planning. We don’t need to go anywhere else, they are the experts when it comes to the case after the case. All of those sticky issues, they easily navigate and let us focus on other issues.

Andrew Knopf
Knopf Bigger

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