The MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has announced a new feature to the current customer service platform, called the Self Service Information Feature (SSIFSelf Service Information Feature (Introduced by MSPRC 9/30/2011)), which will go live on September 30, 2011. The SSIFSelf Service Information Feature (Introduced by MSPRC 9/30/2011) is a new automated approach to providing callers the ability to obtain the most current information available related to demand/conditional payment amounts and the dates the correspondence on these issues were released without having to speak to a customer service representative.
Benefits of this new feature include:
• Extended calling hours – the SSIFSelf Service Information Feature (Introduced by MSPRC 9/30/2011) will be made available for additional hours outside of the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments’s current hours of operation.
• Shorter wait time – by using the SSIFSelf Service Information Feature (Introduced by MSPRC 9/30/2011), callers will no longer have to experience the wait time associated with speaking to a customer service representative.
• Unlimited number of case inquiries on one phone call – after receiving information on a case through the SSIFSelf Service Information Feature (Introduced by MSPRC 9/30/2011), callers are given the option of checking multiple cases on that same call.
Vendors, attorneys, adjusters, and beneficiaries spend a significant amount of time corresponding with the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments in order to obtain status updates and information regarding previously issued demand/conditional payment letters. The implementation of the SSIFSelf Service Information Feature (Introduced by MSPRC 9/30/2011) will provide an elevated level of customer service to the industry as a whole.
PMSI anticipates that additional steps will be taken towards improving service to the industry when Group Health Incorporated (GHIGroup Health Incorporated) begins to oversee the recovery process at the end of the month.
To view the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments update in its entirety, click here.
We have confirmed with CMSCenters for Medicare and Medicaid Services that the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments contract which has been held by Chickasaw Nation Industries (CNIChickasaw Nation Industries) since 2006 will not be renewed when it expires on September 30, 2011. CMSCenters for Medicare and Medicaid Services is seeking to establish a centralized and streamlined Coordination of Benefits (COBCCoordination of Benefits Contractor) and Medicare Secondary Payer Recovery (MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments) operation by consolidating the two units and creating the Medicare Secondary Payer Integration Contractor (MSPICMedicare Secondary Payer Integration Contractor). CMSCenters for Medicare and Medicaid Services posted a source sought notice on August 24, 2011 for the MSPICMedicare Secondary Payer Integration Contractor. To view this posting click here
In the interim, the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has confirmed that Group Health Incorporated (GHIGroup Health Incorporated) will be overseeing the recovery process and is already on site working through the transition with the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments. It is expected that this transition may be a result of the recent hearing before the Oversight and Investigation Subcommittee in June where the conditional payment recovery process and the administrative fees required to recover debts were called into question. This change could lead to additional administrative and/or policy changes in regard to conditional payment recovery. Changes in the recovery process were initiated earlier this month when the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments announced the implementation of a $300.00 threshold where Medicare will not recover conditional payments for liability claims if certain criteria are met. For additional details on the liability recovery threshold please click here to review our blog post regarding this subject.
PMSI is also hopeful that this transition will lead to an improvement in the length of time it takes to verify and resolve conditional payments which would be welcomed by the industry. We will continue to monitor this transition and post additional information as it is received.
What risks are assumed if I don’t submit a workers’ compensation MSAMedicare Set-Aside to CMSCenters for Medicare and Medicaid Services? How do I best protect Medicare’s interests in an upcoming liability settlement? Can I negotiate outstanding Medicare conditional payments after settlement? In order to answer these critical yet complex questions, PMSI will be hosting an educational and accredited legal based webinar to help you navigate through the Medicare Secondary Payer (MSPMedicare Secondary Payer Act) Act. Heather Schwartz, Esq., MSCC, Corporate Counsel for PMSI Settlement Solutions, will offer her compliance expertise Tuesday, October 4, 2011 from 1 PM -2 PM EDT.
PMSI Settlement Solutions’ webinar will help to explain a variety of topics you will encounter while ensuring complete MSPMedicare Secondary Payer Act compliance during settlement:
- • Overview of the MSPMedicare Secondary Payer Act Act
• Submission of MSAsMedicare Set-Asides to CMSCenters for Medicare and Medicaid Services
• State Regulation of CMSCenters for Medicare and Medicaid Services Submission
• Applicability of the MSPMedicare Secondary Payer Act to Liability Settlements
• Medicare Conditional Payments
• MMSEAMedicare Medicaid and SCHIP Extension Act §111 Reporting
• Role of Plaintiff and Defense Counsel in MSPMedicare Secondary Payer Act Compliance
• Protective Settlement Language
• Recent MSPMedicare Secondary Payer Act Case Law
• Legislative Updates
This CLEContinuing Legal Education course has been approved for Florida, California, Kansas, and Missouri. CLEContinuing Legal Education credits are pending for additional states. For more information on obtaining CLEContinuing Legal Education credit for this webinar or to register, please click here
Maryland is again proposing regulations affecting workers’ compensation settlements as it relates to ensuring that Medicare’s interests are protected before a settlement will be approved. The previous proposed regulations from 2010 were never adopted and have expired. It is suspected that they were never adopted due to the fact that the regulations required CMSCenters for Medicare and Medicaid Services submission when CMSCenters for Medicare and Medicaid Services Memos and communications state that the submission process is voluntary and not a mandatory process.
The new proposed regulations are much less stringent and seem to harmonize with CMSCenters for Medicare and Medicaid Services directives in that they allow for approval of settlements without mandating CMSCenters for Medicare and Medicaid Services review and approval of an MSAMedicare Set-Aside. In addition, the proposed regulations require a statement that the insurer shall reimburse Medicare for any conditional payments that are determined to be the responsibility of the employer/insurer in a non-compromise case. These regulations should be more palatable to the workers’ compensation industry and still allow for adequate protection of Medicare’s interests. Public comments can be submitted through October 11, 2011. Following are the pertinent details of the proposed legislation: Continue reading 'New Proposed WC Regulations in Maryland'»
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