Are You at RISK of Medicare Secondary Payer NON-Compliance in 2022?

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Do your claim professionals recognize a claim involving a Medicare Beneficiary in 2022?

Do they understand the full scope of Medicare’s regulatory requirements to consider at the time of settlement? Do your claim professionals recognize the monetary and reputational risk involved if they fail to acknowledge Medicare Secondary Payer (MSP) compliance?

We randomly and confidentially surveyed 36 Property and Casualty payers, including carriers, third-party administrators, state funds and self-insured entities in 2016 to learn about their MSP compliance programs. We learned that most claim departments lacked a centralized, measurable solution to manage and monitor compliance, having fragmented vendor choices. Only 8% of senior leadership had any confidence the claim adjusters could identify and manage MSP and every respondent agreed that MSP delayed or precluded settling claims. Those results were in 2016 when claim department human resources were more stable. Let that sink in!

Fast forward six years later and ask yourself, is the current state of compliance any better?

Now pause and look at current market forces impacting the claims environment, such as:

1) The “Great Resignation” and high turnover

2) Grossly understaffed claim departments

3) Early retirements of top talent having advanced claims domain knowledge

4) Significant Training and Knowledge gaps involving new hires

5) Work From Home disadvantages:  Personal distractions and the loss of ad hoc learning that occurs because of being present in an office.

Do you have a centralized MSP Compliance program that measures and monitors compliance? Do you have confidence that your claim professionals can identify and execute properly to protect injured workers, Medicare, and manage MSP compliance risk to the business? Given today’s workforce climate, these are rhetorical questions!

The market’s inability to measure and monitor compliance will result in fines and penalties as Medicare aggressively seeks to hold primary payers more accountable. What impact will this have on your claim operations? Underwriting models? Customer loyalty?

You are at risk now, more than ever before, of being Medicare’s public example of non–compliance. CMS has made an example of various carriers and law firms in the past to punctuate their compliance expectations.

Be risk averse and act now to use Care Bridge International’s Risk Enterprise MSP Compliance Program that offers the full scope of compliance and resolves all your compliance risks with dashboard analytics for Claim and Risk Management.

Our Walk- Run-Sprint approach is so easy for you to begin! You are just two-clicks away from having 24-hour turnaround time, high quality reports, concierge service,  risk protection and a savings of 40% -70% or more on claims at the time of settlement.


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