The MSP Network, a professional organization created by the Medicare Secondary Payer industry to monitor developments in policy and practice and provide continuing education to members, recently held its annual conference in Baltimore. In-person attendance was back with a virtual option. The participation of CMS administrators and representatives on its Medicare Set-Aside (MSA) review and conditional payment recovery contractors again provided several opportunities for questions and advocacy.
I Approve: On the MSA side, conference topics included the future of zero MSAs and evidence based MSAs plus discussion of developments over whether or not to submit MSAs to CMS for approval. In particular, I appreciated the evidence based MSAs (EBMSA) presentation. Defined as future care plans based on best available research and the clinical expertise of treating medical providers, EBMSAs also encompass patient values and preferences. There is an emphasis on “doing good” for individual claimants and tailoring treatment plans versus utilizing a cookie-cutter approach. Reduced allocation of opioid drugs in MSAs is one example where applying medical research led to better patient care and outcomes.
Options regarding liability MSAs led off the conference, but since then, CMS has withdrawn long-awaited proposed MSP rules for liability claims. Other sessions offered pointers from the MSA review contractor as well as practical advice about pricing of surgeries in MSAs and putting together a successful workers’ compensation MSA submission packet.
The Future Is Recovery: Much of the conference focused on CMS’ conditional payment recovery functions. Representatives of both the Commercial Recovery Center (pre-settlement) and the Benefits Coordination and Recovery Center (post-settlement and self-reported) participated in panels on procedures with useful advice for handling disputes and concerns. Additional conditional payment appeal levels were also highlighted.
Complementing recovery topics were sessions on improvements in the Section 111 mandatory reporting process and looming civil monetary penalties for non-compliance. The implementation of the Paid Act in the past year has facilitated resolution of liens held by Part D & C plans and therefore, expedited settlements. Other settlement strategies were featured including use of professional administration.
Moving forward, there was a program on the collection, sharing, and analysis of MSA approval data. I serve on MSP Network’s Data & Development Committee where efforts are ongoing to increase data collection, assess trends, and interact with CMS policymakers. These activities have previously been consequential, benefitting MSA stakeholders.
In Summary: Sharing experiences and data and having an established relationship with CMS is invaluable to our team of MSP attorneys and paraprofessionals. Here, at NBKL, we are also constantly monitoring the MSP arena and focus on strategies to consider Medicare’s interests while best addressing each claim. Successful MSA proposals and submissions, settlements, and resolution of conditional payment and liens is our goal. Contact any of our team attorneys to discuss how we can assist with MSP compliance and claim handling.