Centers for Medicare & Medicaid Services

CMS relies on HMS's specialized services to help contain the size and expense associated with the federal Medicare program, primarily through coordination of benefits with qualifying Medicare Secondary Payors (MSPs).

In 2005, CMS selected HMS as one of four Recovery Audit Contractors to pilot its demonstration project. Through the project, CMS sought to assess the efficacy of utilizing contingency fee-based contractors to identify and recover Medicare fee-for-service overpayments through two categories: claims review and MSP. Working in two pilot states, HMS has focused on MSP.

HMS helps CMS to identify Medicare beneficiaries who are employed, and then we communicate with the employer to verify employment and determine any group health plan coverage that is available and primary to Medicare. Once all qualifying conditions have been met, HMS submits the necessary documentation to employers and insurers to recoup the Medicare fee-for-service payments for which they are liable.