The Right Solution at the Right Time

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Centers for Medicare and Medicaid (CMS) Townhall at WCI:  A Summary Brief

In case you missed Workers Compensation Institute’s 76th Annual Education Conference in Orlando, August 21-24, there was an interesting panel discussion with leaders from the Division of MSP Program Operations at CMS including Jackie Cipa, Deputy Director, Steve Forry, Director, and John Jenkins, Health Insurance Specialist. 

The panel provided unpublished 2021 statistics regarding the program’s MSP recovery results as follows:

  1. Non-Group Health Plan Medicare Savings due to Conditional Payment recovery – $7.9 Billion
  2. Non-Group Health Plan Medicare Savings due to Future Savings (MSAs) – $1.8 Billion
  3. Total Non-Group Health Recovery Savings – $9.7 Billion
  4. Combined Savings due to Non-Group Health and Group Health Plans – $280 Billion
  5. In 2021, the MSP Program reviewed an average of 1,400 Medicare Set Asides (MSAs) per month

For this year, 2022, the Program has reviewed an average of 1,600 Medicare Set Asides per month. 

The Average Approved MSA is $73,000.00

CMS Average Turn-Around-Time to review an MSA is 7 days, a significant improvement from what we experienced in the past.   We applaud CMS for their success in reducing the turnaround time!

Highlights of CMS Most Recent MSP Initiatives:

  1. NGHP Section 111

a. An Updated Non-Group Health Plan Section 111 User Guide was released in January 2022, and the panel reminded the audience of changes presented in Chapter IV (Technical Guidance) and Chapter 5 (Appendices). When there is an active Medicare Secondary Payer Recovery Portal (MSPRP) account, submitters may choose a Paperless Option.  CMS encourages use of the paperless option.

b. The Office of Information and Regulatory Affairs (OIRA) website shows the Medicare Secondary Payer and Certain Civil Money Penalties (CMS-6061) remain pending. When released, CMS’s Section 111 CMP “final rule” and its “future medicals” proposals will outline the effective date of the long-awaited civil money penalties.   It is imperative that organizations are prepared to report claims accurately involving Medicare beneficiaries to avoid unnecessary and costly fines.  We will continue to monitor as we expect this information may be released soon.

c. Electronic payments are now possible on the MSPRP Portal, and CMS has expanded payment options to both ACH and Credit Card Payments. These electronic payment options are encouraged as an alternative to mailed check payments. 

2. CMS released a Group Health Plan (GHP) Defense Reference Guide in July 2022 and is now in the process of creating a similar guide for Non Group Health Plans. The guide is intended to assist NGHPs in appropriately leveraging forms of defense when the Commercial Repayment Center (CRC) identifies an MSP related debt owed to Medicare.

3. The CMS panel discussed its use of Qualified Independent Contractors (QICs) for use in Appeal / Reconsideration decisions and its anticipated expanded use of the QICs.

4. Regarding Non-Submit Medicare Set Asides (WCMSA), the panel sought to clarify that while the submission of Medicare Set Asides is voluntary and not required, MSAs which exist that are non-submit pose a disadvantage to CMS as the Non-Submit MSA does not allow entry into the CMS Common Working File (CWF) and therefore CMS might err in making a future payment because the existence of an MSA is not known. In other words, the program does not have a means to track a non-submit MSA and this poses a challenge for them in their future recovery efforts.  The panel reminded the audience that regardless of whether the MSA is submitted or not for review and approval, CMS has the authority to recover.

5. CMS Submissions. John Jenkins mentioned an increase in the volume of MSA submissions lacking the required recent 2 years of medical treatment and CMS has experienced an increase in development letters requesting primary payers to provide this information.   A brief, but lively discussion ensued as members of the audience reported the increased difficulty in obtaining current records from providers and facilities and the arduous increase in record subpoenas.  Despite, the challenges of obtaining these records, the panel reinforced that MSAs without the required medical records will not be reviewed. 

How does Care Bridge International compare with the CMS Statistics and Technology based initiatives?

The right solution, for the right time

If you have been following CMS trends over the past ten years you will notice Medicare’s commitment to technology, data analytics, measuring and monitoring and fine-tuning processes to streamline the integrity of its program operations.  For this reason, Care Bridge launched its technology platform to align with CMS initiatives. Our results are demonstrating real value in delivering a risk enterprise approach with data analytics capabilities. Our technology-based platform removes the friction in the Medicare Secondary Payer process, improving overall compliance results, while providing dashboard capabilities to measure and monitor compliance. 

Care Bridge International turnaround time for MSAs – 24 hours

Average Approved MSA – $62,699.47 (15% less than industry average!)

CMS Average turnaround time – 8 days

Care Bridge International turnaround time for Conditional Payments – 24 hours

Conditional Payment Recovery Savings for our Clients – 90%

CMS Average Conditional Payment Negotiation turnaround time – 69 days

Non-Submit MSAs?  No problem.  Care Bridge International uses accurate, defensible data modeling and is the only actuary endorsed solution in the marketplace, our individualized reports are generated in minutes.

What do our customers say?

“Your reports are completed so fast”! – Claim Adjuster, Alabama

“I love the speed of delivery of your reports” – Claim Supervisor, California

“The MSA projections are reasonable, and we are able to settle our claims” = VP of Claims for a TPA

“We owe Care Bridge a “tuition” for all the education provided to us” – CEO

“We are so happy; we want to send all our cases to Care Bridge”! – VP of Claims

“We love the dashboard analytics, something we have needed for many years” – VP, Reinsurance Claims

“Turnaround time was great!!! Thanks for all your help” – Global Carrier, Sr. Claim Adjuster

“The only MSA company that is fast, reasonable and we have had no complaints after 3 years!” -VP

Where to Find Us – We Are On the Move!

IAIABC 108th Convention, September 12-15, 2022, Scottsdale, AZ

Our very own, Deborah Watkins will be a Panelist at this year’s IAIABC 108th Convention in Scottsdale, Arizona!

Deb will be joined on the panel by Industry Consultant, Kim Boyd, and Moderator Sandy Shtab of Healthesystems

The Hot Topic Presented will be Interoperability and Its Impact on the Future of Worker’s Comp

Wednesday • September 14 • 10:30am MST

Innovation Undercover Podcast (TBA), where you get your podcasts

InsureTech Connect 2022, Las Vegas, NV, September 20-22, 2022

MSP The National Medicare Secondary Payer Annual Conference (Virtual), September 21-22, 2022

For More Information Contact Us!