CMS Continues its Liability Medicare Set Aside (LMSA) Recovery Preparations

On December 6, 2018, the Centers for Medicare and Medicaid Services (CMS) announced a notice called “Miscellaneous Medicare Secondary Payer Clarifications and Updates.” We are not aware of any issue that prompted the timing of the announcement, but the content seems to indicate an increased level of attention to Liability Medicare Set Asides (LMSAs):

“This proposed rule would ensure that beneficiaries are making the best health care choices possible by providing them and their representatives with the opportunity to select an option for meeting future medical obligations that fits their individual circumstances, while also protecting the Medicare Trust Fund. Currently, Medicare does not provide its beneficiaries with guidance to help them make choices regarding their future medical care expenses when they receive automobile and liability insurance (including self-insurance), no fault insurance, and workers’ compensation settlements, judgments, awards, or payments, and need to satisfy their Medicare Secondary Payer (MSP) obligations.”

The announcement explains that the proposed rule could be revealed as early as September 2019. Please note the article attached here for further reference that came from a NAMSAP meeting with CMS. The timing of these matters is virtually identical and the new Workers’ Compensation Review Center (WCRC), a CMS contractor to review MSAs, replied to a request for proposal that would obligate it contractually to review LMSAs. This would occur when CMS publishes the parameters for review of LMSAs, including No-Fault claims. The announcement further aligns with the Medicare Learning Network (MLN) Matters Number: SE17019 file notice to providers regarding Medicare Set Asides. Additionally, CMS seems to also focus on post-settlement issues with MSAs, which coincides with the 2017 update to the Reference Guide to “highly recommend” professional administration of MSA accounts.

The announcement also aligns with CMS’ digital strategy and new eMedicare initiatives and Star Ratings program to engage consumers, promote greater access, quality and cost of care delivery for beneficiaries and modernize the program.

As CMS digitizes its platform, Property and Casualty (P&C) insurers continue to grapple with InsurTech to improve claims efficiency and outcomes. Care Bridge International’s Analytic-Powered Medicare Set Aside offers artificial intelligence, based on over 12 million injury claims, to forecast Medicare Set Asides for Workers Compensation, Liability and Auto No-Fault P&C claims. Our easy to adopt Enterprise Risk Management (ERM) platform sets us apart in using artificial intelligence (AI) to generate calculations instantly, instead of days or weeks, at a lower cost. That is why an independent panel of risk managers chose Care Bridge International for the 2018 Business Insurance Innovation Award.

As always, we will keep you informed of the significant updates in Medicare Compliance and how it impacts you.

Deborah Watkins

Chief Disruption Officer

Care Bridge International, Inc.

MSP Compliance Bridge, LLC

Care Bridge International hosts the largest independent Property & Casualty Analytic-Powered Claims Database© in the industry. The company is setting a new standard in forecasting medical treatment and costs for claims using big data analytics and AI technology-based solutions for future medical valuations, medical reserve setting, Medicare Set-Asides and Care Coordination.

Bennett L. Pugh, JD

Chief Executive Officer

Fidelity Fiduciary Company, LLC

A Partner You Can Trust. Fidelity Fiduciary Company, LLC (FFC) was founded in 2001 when leading workers’ compensation experts recognized an industry-wide need to provide a resource of competent and compassionate payers to guide and assist the more complex injured workers’ financial needs


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