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House Subcommittee Hears Testimony on Medicare SPS

Margaret Dick Tocknell, for HealthLeaders Media, June 23, 2011

Deborah Taylor, CFO and the director of financial management centers for CMS, said the MSPS law is an "important mechanism for protecting the fiscal integrity of the Medicare program and the Medicare Trust Fund. Over the last decade, total MSPS savings have exceeded $50 billion."

She noted that all insurance providers, public and private, utilize a system similar to the MSPS program to resolve conflicting coverage issues with other carriers.

Taylor laid much of the responsibility for any problems at the feet of non-group health plans (NGHP), which include liability and no-fault insurance, and workers' comp plans. She noted that new reporting requirements were adopted in 2007 for employer-sponsored group health plans and NGHPs but that the "NGHP industry's unfamiliarity with MSPS rules" had led to confusion related to reporting requirements.

In his testimony James C. Cosgrove, director of healthcare for the GAO, stated that although Congress added mandatory reporting requirements in 2007 for group health plans and NGHPs the requirements were relaxed at the request of the industry and would not be in full effect until 2012.

Cosgrove said "the Congressional Budget Office estimated that these provisions for group health plans and NGHPs would save Medicare $1.1 billion over 10 years in improper payments that could be recovered or avoided by Medicare."

Marc Salam, vice president of risk management for Publix Super Markets, spoke as a member of the Medicare Advocacy Recovery Coalition or MARC Coalition, which advocates for changes in the MSPS. Among his concerns is that the current system prohibits CMS from revealing how much it has spent on medical coverage when a liability case is involved.

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