In 2026, Medicare Secondary Payer (MSP) compliance is no longer sitting quietly in the background of claims operations. It is front and center—shaping how claims are handled, how settlements are structured, and how risk is managed across organizations.
For claims adjusters, claims leaders, risk managers, employers, carriers, and attorneys, the reality is simple: MSP compliance is no longer optional, and it’s no longer someone else’s
problem.
This article aims to look at what’s changing, why it matters, and how claims departments can prepare—without getting lost in technical or legal jargon.
Why MSP Compliance Is Getting More Attention in 2026
For many years, MSP compliance felt manageable. Reporting happened in the background. Most issues surfaced long after claims were closed, if they surfaced at all.
That dynamic has changed.
Federal oversight has increased, data systems are far more sophisticated, and past reporting errors are now easier to identify. As a result, claims departments and employers are being evaluated not just on outcomes, but on accuracy, documentation, and consistency.
At the center of this shift is the Centers for Medicare & Medicaid Services (CMS). CMS relies heavily on automated systems to review data and identify inconsistencies. These systems don’t assess intent or context—they simply flag what doesn’t match.
That means even small errors can create real exposure.
Three MSP Risk Areas Claims Teams Need to Understand
1. Mandatory Insurer Reporting Is Under a Microscope
Mandatory Insurer Reporting (MIR) has always mattered. In 2026, it matters more than ever. CMS systems are actively identifying issues such as:
- Incorrect Medicare beneficiary status
- Inconsistent injury or diagnosis coding
- Improper ORM start and termination dates
- TPOC amounts or dates that don’t align with the file
These aren’t theoretical risks. They are data points that CMS systems can now flag quickly and automatically.
The takeaway for claims teams and employers is straightforward: accuracy matters at every step, even when the claim feels routine.
2. Settlements Don’t End MSP Exposure
Many claims professionals still think of settlement as the finish line. From an MSP perspective, it often isn’t.
In recent years, CMS reviews tied to workers’ compensation settlements have become more common—and they often happen well after a claim is closed. When problems arise, the focus isn’t just on the settlement amount, but on how Medicare’s interests were handled and
documented.
If MSP issues weren’t addressed clearly and correctly at the time of settlement, organizations may find themselves revisiting old files under far less favorable conditions. For attorneys, carriers, and employers, this means MSP decisions made today can have long-term financial consequences.
3. MSP Compliance Is an Operational Issue, Not Just Legal
One of the biggest misconceptions about MSP compliance is that it belongs solely to legal teams.
In reality, MSP risk touches nearly every role in the claims process:
- Adjusters entering claim and injury data
- Supervisors approving settlements and reserves
- Vendors providing medical records and reporting support
- Executives responsible for oversight and governance
When MSP knowledge lives in a silo, mistakes are more likely. When it’s integrated into
everyday workflows, risk becomes easier to manage.
What Prepared Claims Departments Are Doing Now
Organizations that are ahead of the curve aren’t waiting for enforcement letters or post-settlement surprises. They’re taking practical steps today.
Building Awareness Across the Team
Not everyone needs to be an MSP expert. But everyone involved in claims should understand:
- Why Medicare status matters
- When questions should be escalated
- How small reporting errors can create larger issues later
Reviewing Reporting Before Problems Appear
More claims organizations are conducting proactive reviews of their reporting processes. The goal isn’t perfection, it’s early identification of gaps before they turn into liabilities.
Treating MSP as Part of the Claim Lifecycle
From first notice of injury through settlement, MSP considerations should be addressed consistently, not rushed at the end of a file.
The Risk of Waiting Until 2026
Claims departments that delay preparation often face:
- Reactive responses to CMS inquiries
- Increased legal and administrative costs
- Settlement delays or reopenings
- Unnecessary disruption to operations
Those that prepare early tend to see the opposite: smoother settlements, fewer surprises, and greater confidence in their compliance posture.
Final Thought
The MSP landscape in 2026 will reward claims organizations that take a thoughtful, proactive
approach.
This isn’t about overreacting to regulation. It’s about recognizing that accurate data, consistent processes, and informed decision-making protect everyone involved, employers, carriers, attorneys, and injured workers alike.
Claims teams that invest now won’t just reduce risk. They’ll operate with greater clarity, confidence, and control in an increasingly complex environment.