As the government shutdown drags on, we’ve heard more and more questions about what does this mean for MSP compliance. Well, the good news is that most Medicare Secondary Payer activities are undertaken by government contractors who are unaffected by the government shutdown. Here’s a brief primer on common MSP compliance activities and the impact (or lack thereof) of the government shutdown.
Medicare set-aside reviews – All workers’ compensation MSAs are reviewed by the Workers’ Compensation Review Contractor (WCRC). As the name suggests, the WCRC is a government contractor that is working at full capacity. ECS evaluated MSA review turnaround times in October and compared them to September and year-to-date and confirmed that there was no impact to MSA review turnaround times from the government shutdown. On average, we are seeing MSA responses in about 2-3 weeks from the date the submission is received (sometimes slightly less or slightly more). So, keep those MSAs coming! Our planners and compliance attorneys are ready, willing, and able to assist in every way possible at making your settlement sail through successfully.
Conditional payment dispute, appeals, and investigations – Conditional payment recovery is performed by either the Commercial Repayment Center (CRC) or the Benefits Coordination and Recovery Contractor (BCRC). Guess what? Two more contractors. As with MSAs, we are seeing no impact in our ability to obtain a conditional payment amount and there’s no impact whatsoever to the response time on conditional payment disputes ore appeals. Most ECS customers are enrolled in Go Paperless notifications, allowing essentially same day notice of conditional payment results, and Go Paperless is similarly unaffected because it is run by the BCRC.
Section 111 reporting – As we indicated last month, we anticipate CMS to release an updated User Guide and announce changes to the mandatory WCMSA reporting process. The shutdown has placed those announcements on hold for the time being. In fact, given the shutdown, we would anticipate that any changes that CMS anticipated making would be delayed by the way in which the agency stages communication. Major changes require six months’ advance notice, and we do not anticipate that CMS will release announcements immediately after the end of the shutdown. For now, we simply have to wait on any changes. Day-to-day section 111 reporting is overseen by the BCRC and those activities remain in place with no disruption. Do not let the shutdown stop you from reporting – it’s imperative that claims are timely, accurately, and completely reported in order to avoid civil money penalties.
Social Security verifications – On occasion we need to communicate directly with the Social Security Administration in order to verify a person’s Social Security Disability entitlement. The SSA remains open for essential services. Guess what is not on the list of essential SSA services? Social Security verifications. ECS is having some success with obtaining response to SS verifications on some cases, but there are a number of cases where the verification is hung up due to the government shutdown. While we do expect resolution of this backlog shortly after the resumption of normal government activities, we (along with everyone else) have no idea when that will be. In the meantime, we recommend that anyone with a question about Medicare or Social Security status that’s relying upon the SSA for a written verification contact our Compliance Team at mspcompliance@examworkscompliance.com.
What’s next? Like most of you, we continue to await a resolution of the current government shutdown. In the meantime, we have a list of wishes for CMS as we approach Thanksgiving. We’d love and be forever thankful if CMS quickly addresses the WCMSA reporting concerns that we’ve raised since the summer. We’d love answers on any changes that will be made to WCMSA reporting and other Section 111 updates. We await CMS’ annual MSA report, outlining the volume of MSAs submitted to CMS and the average response. And we would love for the agency to be able to engage meaningfully with the regulated community.
Until that time, we remain busy and ready to serve you. If you have any questions at all about the government shutdown and the impact to your claim please contact your local ECS regional compliance consultant or the ECS Compliance Team at mspcompliance@examworkscompliance.com.
