Today, CMS officials were slated to host a highly anticipated national webinar on mandatory Medicare Set-Aside reporting. Instead, with the government shutdown, the session has been “postponed until further notice.” .
The webinar was expected to explain the issues faced under the newly implemented Section 111 WCMSA reporting process. CMS had encouraged stakeholders across the industry - beneficiaries, attorneys, agents, and claims payers - to attend this important informational webinar.
While we understand the delay, we still need clarity. To keep the conversation moving, and as a bit of a hat tip to our Five Key Takeaways feature, we’ve outlined the top five areas we hope CMS tackles once this webinar is rescheduled.
- Be transparent about what is happening. CMS should provide a clear explanation of what they are doing with the mandatory MSA reporting data, how that information is being shared internally and among the various systems that CMS maintains, and how that information is being communicated with the Workers’ Compensation Review Contractor, which is the entity responsible for reviewing Medicare Set-Asides.
- Provide Guidance on Complex Settlements. Currently, guidance on settlements involving multiple claims payers and/or multiple dates of loss is incomplete and inadequate. As a result, CMS still needs to address these scenarios within the framework of existing TPOC policies, especially since there is no actual Section 111 civil money penalty associated with the receipt of mandatory MSA reporting data.
- Explain what happens when TPOC is reported while a CMS submission remains pending. CMS should acknowledge what many submitters, claims payers, and others already know. In cases where a TPOC report is provided CMS is suspending review (and more) of previously submitted claims that are still under review by the WCRC. CMS should confirm how such cases will be treated so the regulated community knows what to expect going forward.
- Provide updated communication guidance. We would implore CMS to commit to updating impacted beneficiaries, claims payers, and submitters whenever mandatory MSA reporting data impacts submitted MSAs that are either under review or that have been previously approved by Medicare. As of now, submitters are left in the dark Written, proactive, correspondence from CMS would go a long way toward reducing confusion and increasing consistency.
- Publish a timeline for anticipated changes. We would ask that CMS provide the industry with a list of anticipated changes (if possible) and (at the very least) a timeline for how long those changes will take to deploy. A timeline, even if approximate, would allow a head start for IT, claims departments, experts, and attorneys to prepare, test, and develop any necessary adaptations.
CMS may not be able to provide this webinar until after anticipated NGHP User Guide changes or a highly anticipated series of discussions at this month’s upcoming National MSP Network Conference in Baltimore. Whenever the agency is able, we hope this top 5 list of topics are high on the agenda. In the meantime, our team will continue monitoring developments closely. Until then, if you have any questions about mandatory MSA reporting reach out to the ECS Compliance Team at mspcompliance@examworkscompliance.com.
This post was co-authored by Neha Pellegrino, Esq. Neha is a Sr. MSP Compliance Counsel at ExamWorks Compliance Solutions. A licensed Massachusetts attorney with more than fifteen years of experience in providing dedicated Medicare compliance advice to settling parties, Neha is a graduate of the University of Connecticut (go Huskies!) and Suffolk University Law School. She can be reached at 978-501-1178 or neha.pellegrino@examworkscompliance.com