Medicare Secondary Payer: What to Expect in the New Year
JANUARY 11, 2023
There were several significant changes in Medicare Secondary Payer compliance last year that made interested stakeholders take notice. Given the current political climate, it is unclear what changes will take place in the coming year. Notwithstanding this uncertainty, all parties involved in workers’ compensation claims must take notice as we embark on another year.
What Changed in 2022?
Last year CMS started it with a bang by announcing a significant policy shift in version 3.5 of the WCMSA Reference Guide. The changes included Section 4.3 – The Use of Non-CMS-Approved Products to Address Future Medical Care – of the WCMSA Reference Guide:
Warning about not submitting cases to CMS for review and approval and using other “evidence-based” tools;
Warning to parties who avoid the WCMSA review and approval process when a settlement meets workload review thresholds; and
Warning about other insurance-based products that indemnify parties against adverse CMS actions.
The main objection to these policy changes was a consistent and fair application of the Medicare Secondary Payer Act. CMS conducted a Townhall telephone conference the following month to address these concerns and eventually softened its stance two months later in version 3.6 of the WCMSA Reference Guide.
Setting Up an Effective Compliance Program in 2023
It is unclear what changes will occur to the Medicare Secondary Payer Act in the coming year. Although there is a partisan split in Congress, any change to the Medicare Secondary Payer Act will likely come in legislation precisely, and that remains unforeseeable. There is even more uncertainty about any significant policy changes by CMS. Given the recent withdrawal of rulemaking related to Medicare Set-asides in personal injury cases, it is doubtful CMS positioned to prepare and implement policy or rulemaking changes.
Now is the time to remain vigilant and continue to work with MSA Source to bolster your compliance program.
Contact MSA Source to review your Medicare Secondary Payer compliance program and determine if there are opportunities to bolster your efforts to comply with the Act and remain aggressive.
Contact MSA Source with questions on how to avoid “counter-higher” and establish case triggers to be more proactive on compliance matters; and
Contact MSA Source to serve as a conduit between your claim team and defense counsel. This can also include involving our team in claim roundtables and training.
Use the new year to review the staff at your service provider who prepares Medicare Set-asides.
Conclusions
The new year presents many challenges regarding understanding and complying with the Medicare Secondary Payer Act. MSA Source is here to serve you and enhance your Medicare compliance program to drive settlements and claim savings.