stand-alone HRAs and Medicare coordination of benefits

[Guest RTMoore]

Hello all,

Starting in a couple of months, stand-alone Health Reimbursement Arrangements (HRAs) have to report coverage information to the Centers for Medicare and Medicare Services (CMS). It doesn't matter whether it's managed by a TPA or an employer, it all has to get reported (with some small exceptions). The reporting includes SSNs, names, birth dates, and whether the employee is "covered" by the HRA. Reporting does not include whether the employee has exhausted the HRA nor the amount remaining in the HRA.

Reporting is a pain, but the bigger issue is how the coordination of benefits (COB) would work between a HRA, the medical provider, and CMS. CMS has declared that HRAs are a primary payer, but most HRAs only provide reimbursement to the employee for an eligible medical expense. So, will CMS start sending claims made by the employee's providers to employers and TPAs since they are technically listed as "primary payers"?

You can think of a system where CMS requires the provider to send the bills first to the employer or TPA as the listed-primary-payer only to have the TPA or employer deny every "claim" since its being requested by someone other than the HRA plan participant. Similarly in the case where a employee has exhausted his or her HRA dollars, is CMS going to come back to the employer and TPA and demand payment even though the HRA is already maxed out?

Does anyone have any experience with how an employer or TPA might deal with the onslaught of CMS COB issues?

Regards,

RT Moore