As a first-time NAMSAP (National Alliance of Medicare Set-Aside Professionals) annual conference attendee, I was able to meet, learn from, and network with many leaders and influencers in the Medicare Set-Asides (MSA) and Medicare Secondary Payer (MSP) compliance industry. NAMSAP is about collegiality among adversaries and competitors while its conference provided opportunities for policy discussion and problem solving. Our own NBKL MSA leader, Amy Bilton, is the current NAMSAP President and opened the September 18th & 19th Baltimore conference titled “All In.”
In my opinion, there are two main takeaways from this year’s conference. First, CMS is actively interested in feedback from and communication with MSP professionals and practitioners. Three Centers for Medicare and Medicaid Services’ (CMS) representatives attended both days of the conference and managers with the recovery contractors – the Commercial Repayment Center and Benefits Coordination and Recovery Center – participated on individual session panels. John Albert, Senior Technical Advisor, Division of Medicare Secondary Payer Operations in the Office of Financial Management for CMS gave the keynote address, stressing CMS is interested in developing usable data. He commented that Section 111 mandatory reporting updates and clarifications are as important as the initial reporting. He announced upcoming changes to the Workers’ Compensation MSA and MSP recovery portals and stated that electronic submission of annual attestations for MSA administration is coming. This ability will assist proper payment, document exhaustion of MSAs, and provide improved data for better allocations. Along with Steve Forry, the Division Director of Medicare Secondary Payer Program Operations, and John Jenkins, a Health Insurance Specialist in charge of the MSA review contract, all three engaged in Q&A sessions on many topics, acknowledging issues and concerns and offering solutions and assistance.
The second takeaway was that MSP compliance parties and players share the same objective of considering Medicare’s interests to protect the Medicare Trust Fund and should work together. Medicare Set-Asides and compliance and recovery measures are tools to meet the burden imposed by federal law and collaboration, and cooperation from all sides and interests can improve the system. That’s what NAMSAP is all about. One area of ongoing concern is the resolution of conditional payment claims – those medical expenses paid by Medicare prior to the settlement of a workers’ compensation or liability case. Conference participants cited duplicate claims and inadequate, or even non-existent, review of disputed conditional payment claims. Many raised the difficulty in resolving conditional payment claims after a settlement when CMS looks to the beneficiary for recovery, though an employer has accepted responsibility for related amounts. Conversely, CMS will often seek recovery from an employer despite a case being completely denied and disputed with no accepted responsibility for payment of medical expenses. In the liability arena, additional conditional payment cases are opening despite notification to CMS of exhaustion of benefits. Attendees were encouraged to forward examples of individual problematic cases to CMS for direct assistance.
Other topics and highlights of the conference included the following:
- Opioid use in MSAs in on the decline. Since 2017, professional MSA administrators have noticed a general decrease in usage. CMS-approved MSA patterns also show downward changes in opioid allocations.
- Professional administrators report actual post-settlement care often differs from projected Set-Aside allocations. Medical advancements and newly developed drugs contribute to this status. While there are low MSA exhaustion rates, non-fee schedule billing and drug costs still lead to dissipation of MSAs and CMS does track full exhaustion of MSAs.
- Formal guidance for liability MSAs is still pending with compliance placed primarily on claimants/beneficiaries. Until then, a good faith approach based on all facts is the best practice.
- Non-submission, legal zero MSA criteria may become part of the WCMSA Reference Guide. Non-submission Evidence-Based MSAs are also gaining interest.
- Hearings on the Merits can have an impact in liability and high-exposure workers’ compensation claims. Again, an adversarial but cooperative approach in presenting a complete record before a court/trier of fact is key to defining Medicare’s proper interests.
- Primary payers are not using CMS’ online payment system. Payer options like EFT or ACH transactions are under consideration.
- Medicare for All remains on the table. Senator Sanders’ bill contains a reimbursement provision. Some panelists predict an expansion of Medicare to those 55 and older and including home health care under Medicare coverage.
I was proud to attend the NAMSAP conference with firm colleagues who have taken on officer and board positions and serve on several committees. Working closely with CMS and legislators on improvements; the collection, analysis and sharing of data and trends; developing procedures for liability MSAs; and addressing the opioid crisis are important and exciting objectives. I have become better informed through participation in NAMSAP and am motivated to become more involved.