house of delegates resolutions

Supports Timely Resolution of Medicare Reimbursement Claims

RESOLVED, That the _ supports timely and efficient resolution of requests from a claimant or applicable plan for conditional payment reimbursement amounts where Medicare has a right to reimbursement from a recovery by way of settlement, judgment or award for payments made for items and services.

FURTHER RESOLVED, That the _ urges Congress and the Department of Health and Human Services, by legislation and/or regulation, to establish reasonable time limits and procedures for responding to requests for conditional payment reimbursement amounts so that payments of settlements, judgments and awards and reimbursements to the Department and taxpayers is timely, and failure by Medicare to timely respond should result in waiver of its right to seek reimbursement.

FURTHER RESOLVED, That the _ urges the adoption of legislation and/or regulation which establishes the right of appeal and appeals process with respect to any determination for a payment made for an item or service under a primary plan under which the plan, attorney, agent or third party administrator may appeal such determination.