May 2012
The New Medicare Secondary Payer Recovery Portal (MSPRP) Coming July 2012
The Centers for Medicare & Medicaid Services (CMS) is in the process of implementing a new web-based tool designed to accelerate the resolution of Liability Insurance, No-Fault Insurance, and Workers' Compensation Medicare recovery cases. The new tool is called "The Medicare Secondary Payer Recovery Portal (MSPRP)". The MSPRP will give users (attorneys, insurers, beneficiaries, and TPAs) the ability to access and update certain case specific information online. Activities that currently require written communication or telephone calls to the Medicare Secondary Payer Recovery Contractor will be able to be done through the portal in July 2012.
Blackburn Group will be an inaugural participant when the new Online Self-Service Tool is Scheduled for activation in July 2012.
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Court Finds Liability Medicare Set-Aside (MSA) Adequately Protected Medicare - In Louisiana US Western District Court, Judge C Michael Hill Finds Liability MSA Adequately Protected Medicare's Interests.
In the case of Frank v. Gateway Insurance Co et al, it was ordered by Judge Hill that to the extent that Frank receives confirmation from Medicare of any conditional payments made by Medicare for services provided prior to the date of the order, Frank shall promptly reimburse Medicare for such conditional payments. It was further ordered that Frank shall provide funding for $3,200.00 out of the settlement proceeds for payment of future medical items or services, which would otherwise be covered or reimbursable by Medicare, related to what was claimed and released in this lawsuit. The fund for Frank's future medical expenses will be deposited into an interest-bearing account for the purpose of paying any future medical items or services that would otherwise be covered or reimbursable by Medicare that are related to what was claimed and released in this lawsuit.
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The US General Accountability office (GAO) Recently Releases Report To Improve Program Effectiveness for Non-Group Health Plans (NGHP)
In early April, the GAO released their report of various efficiencies and inefficiencies of the MMSEA Section 111 NGHP programs. Someof the efficiencies include net savings of $100 million dollars per year. The "savings" are essentially claims denials and conditional payment recoveries attributed to liability insurance. GAO did not quantify the added costs of regulatory compliance on NGHP insurers, which may be the subject of future Congressional hearings. The GAO criticized CMS's implementation of mandatory reporting which included certain details about extended timeframes to resolve open cases by the Medicare Secondary Payer Recovery Contractor (MSPRC).
GAO offered five recommendations to CMS for improved reporting and administration of the MMSEA Section 111 reporting and Medicare Set Aside programs.
- periodically review reporting thresholds,
- consider making the reporting of ICD-9 codes optional,
- improve the Section 111 website,
- provide more guidance on the use of Medicare set-aside arrangements, and
- improve correspondence with Medicare beneficiaries.
CMS's comments largely concurred with each of the recommendations except the second recommendation regarding ICD-9 codes. Blackburn Group has advocated for years to have the Centers for Medicare and Medicaid Services (CMS) improve their rules and operations, and we are taking advantage of all of the newest technology to eliminate time and cost for customers.