Medicare RDS Cost Reports

Core Concept: Produce reports of paid retiree retail pharmacy claims in order for the employer/union to receive a subsidy from CMS for retaining their retirees on their drug program.

Provide Retiree Drug Subsidy Reporting to employers/unions seeking the CMS 28% tax free subsidy from Medicare Federal Trust Fund. There are over 50,000 employers that have pursued RDS for 2006. 

In many instances an Employer may have their retiree prescription benefit split between multiple PBMs or health plans which may require an aggregation of eligibility and cost data files. If these retirees are under the same application and unique benefit option it may be necessary to combine the data for the submission of cost reports to CMS to acquire the subsidy. The cost data and subsequent RDS payments are subject to the False Claims Act and therefore employers need to be sure to follow the RDS Payment Guidelines as accurately as possible.   SPN can take claims data and eligibilty information from a variety of sources, in any format, and accurately produce the CMS cost reprorts.