Vasilios J. Kalogredis, left, and Rachel E. Lusk Klebanoff, right, of Lamb McErlane. OIG Opinion: Providers Can Share a Portion of Reimbursements With MSP Patients
On Dec. 28, 2020, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) published Advisory Opinion 20-07, approving a proposal whereby certain health care facilities and clinicians could use an online platform to disburse, to patients and the patients' payors, a portion of the reimbursement the facilities and clinicians, receive for claims where Medicare is a secondary payor.
January 25, 2021 at 11:26 AM
7 minute read
On Dec. 28, 2020, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) published Advisory Opinion 20-07, approving a proposal whereby certain health care facilities and clinicians could use an online platform to disburse, to patients and the patients' payors, a portion of the reimbursement the facilities and clinicians, receive for claims where Medicare is a secondary payor.
The requestor of Advisory Opinion 20-07 operates a web-based platform that lists, with certain categorical exceptions, all known health care facilities and clinicians with a national provider identifier (NPI), as well as certain information about each provider, including their specialties, services offered and rates for specific services. Through its existing platform, the requestor allows providers to disburse a portion of paid claims to patients and nongovernmental third-party payors for diagnostic, procedural, and surgical care that is both elective and episodic (eligible care). Under the current arrangement, the amount the providers disburse may be higher than the patients' cost-sharing obligations for the eligible care.
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