CMS Medicare Secondary Payer (MSP) October 2020 Updates
October has been a dynamic month for followers of Medicare Secondary Payer. On October 5th, The Centers for Medicare and Medicaid Services (CMS) released Version 3.2 of the WCMSA Reference Guide. Within the update, CMS summarizes the major medical centers that the Workers’ Compensation Review Contractor (WCRC) references to price medical expenses in WCMSAs. The pricing of surgeries and procedures as determined by MSA Submitters versus the CMS Workers Compensation Review Center (WCRC) has been quite contentious for some time. This new pricing transparency with major medical centers is an attempt to decrease pricing disparities among the parties.
Consistent with the enactment of the final rule for hospital pricing transparency, effective January 1, 2021, CMS requires hospitals to provide a comprehensive machine-readable list of items and services, in a consumer-friendly format. As pricing transparency evolves, there may be ongoing opportunities to align submitter pricing with that of CMS, further reducing and eliminating these types of discrepancies in the CMS MSA approval process and we will continue to monitor this development.
On October 5, 2020 CMS also issued an updated version of the MMSEA Section 111 NGHP User Guide 6.0. This latest version of the User Guide clarifies the computation of TPOC amounts as follows “The computation of the TPOC amount includes, but is not limited to, all Medicare covered and non-covered medical expenses related to the claim(s), indemnity (lost wages, property damages, etc.), attorney fees, set-aside amount (if applicable), payout totals for all annuities rather than cost or present values, settlement advances, lien payments (including repayment of Medicare conditional payments), and amounts forgiven by the carrier/insurer.” The guide also clarifies that indemnity-only settlements do not need to be reported, and provides an updated list for 2021 of excluded ICD codes, or codes which should not be used for Section 111 reporting purposes.
Additionally, while CMS did not release an updated version of the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) user guide October 5th, CMS did add a new feature to the WCMSA Portal (WCMSAP) requiring the submitter to confirm any costs associated with the use of a major medical center and if yes, provide the zip code for the major medical center used in the appropriate data field.
Following the launch of these CMS updates, the 2020 NAMSAP (National Alliance of Medicare Set Aside Professionals) Annual Conference took place, virtually, October 6-7, 2020. An announcement was made that the organization has changed its name to The National Medicare Secondary Payer Network . The conference agenda included a variety of presentations, including discussions with key representatives from CMS.
One presentation focused on Provide Accurate Information Directly Act or PAID Act (S.1989/H.R. 1375). This bill, if passed, would require CMS to provide information about whether a beneficiary is enrolled in a Medicare Advantage or Part D plan, along with the name and identification of the plan, through the MMSEA section 111 query process.
Meanwhile we, at Care Bridge International, have immediate access to this information whether we act as our clients Section 111 reporting agent or not. As part of our service delivery, we secure the Medicare Part D and/ or Medicare Advantage Plan eligibility with the specific plan information in minutes so we can inform our clients immediately of these exposures. While CMS guidance for Liability Medicare Set Asides (LMSA) and penalties involving Section 111 reporting remain pending, by all accounts is imminent, we will continue to keep you apprised of important CMS Medicare Secondary Payer announcements.
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