With 2012 over, it appears that those affected by the MSP can look forward to an extremely bright and optimistic 2013. In 2012, CMS and the new WCRC vendor, Congress, and the DHHS were more proactive than ever in taking steps to reform and improve the MSP program. These 2012 reforms touch upon and impact conditional payment reimbursement obligations, WCMSA approvals, as well as Mandatory Insurer Reporting pursuant to MMSEA Section 111. Below we have highlighted three items that demonstrate the progress made with regard to MSP and MMSEA Section 111 reforms in 2012.
SMART Act Passes Both Branches of U.S. Congress
As mentioned in a previous blog, the SMART Act passed the U.S. House of Representatives on December 19, 2012. On December 21, 2012, just two days later, the U.S. Senate also approved the legislation. Today, on January 10, 2013, President Obama signed the legislation which made the Act effective.
The SMART Act provides MSP reform as it affects conditional payment collection and MMSEA Section 111 reporting. Some examples of the approved reforms are to set the statute of limitations for conditional payment recovery at three (3) years and implement an annual threshold wherein conditional payment reimbursement and MMSEA Section 111 will not apply. Additionally, it will make the MMSEA Section 111 penalty of $1,000 per claim/per day discretionary rather than mandatory and remove the requirement to provide SSNs/HICNs from the reporting process.
Now that the SMART Act has been signed by the President, it will set these reforms into motion and will also require CMS to review their processes on an annual basis and to publish proposed rules in which comments from the industry will be sought. Passage of the SMART Act will bring needed reform to conditional payment reimbursement and MMSEA Section 111 obligations in 2013.
CMS Approves Large Backlog of WCMSAs
In early December, CMS provided notice to submitters of WCMSAs that it had processed and reviewed a large number of backlogged WCMSAs. Click here for our prior blog regarding this topic.
After reviewing these approvals, it appears that CMS approved the majority of WCMSAs as submitted. In reference to PMSI’s backlogged cases, only a very small portion (less than 1%) were not approved “as is” by CMS, mostly due to clerical error within the determination letter.
This action by CMS, not only to clear such a large number of backlogged cases, but to approve the majority of submitted allocations “as is” was extremely positive and proactive allowing settlements that were held up waiting on CMS to approve the WCMSA to now take place.
Restrictions on Quarterly File Submissions Lifted for NGHP RREs
In May of 2012, CMS issued an alert stating RREs would be able to submit more than one quarterly MMSEA Section 111 claim input file. For more information on this alert, please see our prior blog. This change by CMS allows RREs the opportunity to better comply with MMSEA Section 111 requirements and for better coordination of benefits for Medicare beneficiaries. CMS continues to make changes to the MMSEA Section 111 program on a regular basis and released an updated User Guide on July 3, 2012, which included this change.
Congress passing the SMART Act, the large backlog of WCMSAs being cleared at CMS, and updates to improve the MMSEA Section 111 process are just a few examples highlighting the light at the end of the tunnel in 2012. Here’s to an even better 2013!!!!