February 2011

CMS Approval is Taking Longer for WCMSA; Liability (LMSA) is Quicker

Recent intelligence by our CMS Submission Department with the Centers for Medicare and Medicaid Services (CMS) has shown that there has been a significant slowdown in the national review process of Workers Compensation Medicare Set Asides (WCMSAs) with CMS. Most submitted cases by the insurance industry as a whole last year took anywhere between 60-90 days for approvals assuming there was no request by CMS for additional information. Since the start of this year, it appears WCMSAs are taking between 4-6 Months for Approval due to the start of Mandatory MMSEA Section 111 Data Reporting and greater workloads for CMS personnel. On the flipside, Liability Medicare Set Aside (LMSAs) approvals are about the same time frame as last year. The Approval times are anywhere between 30-45 days assuming there is no request by CMS for additional information. We wanted to let everyone know that CMS is working hard to move all Submissions at a quicker pace and we will continue to monitor and work with them to obtain the latest developments and share with you as they come available.

Medicare Set Asides in Liability Insurance, Self Insurance, & No Fault

Liability insurance (including self-insurance) is coverage that indemnifies or pays on behalf of the policyholder or self-insured entity against claims for negligence, inappropriate action, or inaction which results in injury or illness to an individual or damage to property. It includes, but is not limited to the following insurance or self-insurance: General Liability, Homeowners Liability, Automobile Liability, Product Liability, Malpractice Liability, Uninsured Motorist Liability, Underinsured Motorist Liability, and Third Party Liability. Insurance proceeds are also primary to Medicare. To the extent that a liability settlement is made that relieves a Workers Compensation carrier from any future medical expenses, a CMS approved Medicare set-aside arrangement is appropriate. This Medicare Set Aside would need sufficient funds to cover future medical expenses incurred once the total third party liability settlement is exhausted.

What's Inside the MSP Fact Sheet for Your Providers and Physicians?

You may have heard recently that maintaining the integrity and viability of the Medicare Trust Fund has become more and more critical as the "baby boomer" generation moves towards retirement and the Medicare Program matures. Did you realize that Providers, Physicians, and other suppliers on your claims can contribute to the appropriate use of Medicare by ensuring they are complying with all of the Medicare requirements, including those applicable to Medicare Secondary Payer (MSP) Provisions? Interestingly enough, there is a fact sheet designed by Medicare just for this purpose which provides a general overview of the MSP Provisions for individuals involved in the admission and billing procedures at the Physician, Provider, and other supplier levels.