Time for Spring Cleaning: Five Things You Can Do to Improve Your MSP Compliance Program
March 11, 2025
By: Aaron P. Frederickson, Esq. - MSP Compliance Attorney for MSA Source
Springtime is near. This is a time when Americans traditionally undertake cleaning their homes. One can undertake various tasks – dust ceiling fans and light fixtures, clean window sills and tracks, vacuum curtains, and blinds, and wipe down baseboards. The list is endless.
Interested stakeholders can do the same regarding their Medicare Secondary Payer compliance programs. Here are five things you can do to prepare for the coming year.
1. Amended Review Process: Starting on April 7, 2025, CMS will no longer require submitters to wait one year to use the Amended Review process. One should proceed with caution when using the Amended Review process. CMS can increase its initial MSA amount upon review of the new submission. There are no guarantees of a lower amount upon receiving approval.
2. Zero Medicare Set-aside Allocations: Effective July 17, 2025, CMS will no longer review proposed $0 Medicare Set-aside allocations. Now is the time for stakeholders to understand what constitutes a $0 allocation and how to navigate the voluntary review and approval process. Proceed with caution – all settlements must consider Medicare’s interest, and abuse of the new policy will result in adverse future action. Coordinate efforts with service providers like MSA Source to understand a third-party review of proposed allocations will benefit everyone.
3. Civil Monetary Penalties: The first civil monetary penalties will be issued in late October 2025. Now is the time to review your compliance program to ensure correct claims reporting. Being proactive now will pay dividends in the future.
4. Consider legal drafting in all Settlements: Obtaining a Medicare Set-aside allocation and having it reviewed by CMS is part of the equation. The best compliance practices include language in your settlement agreements that outlines why the allocation is reasonable, the dollar amount of the Medicare Set-aside, how it will be funded, who is responsible for the administration of the account, and the all-important reversionary clause.
5. Education is Key: Now is a great time to schedule continuing education courses for your office. Ongoing education allows everyone to learn together and stay current on changes to Medicare Secondary Payer compliance issues. These programs can be in-person or remote and are best held over lunch.
Now is the time to prepare for spring cleaning and promote the best practices for Medicare compliance. MSA Source is here to be a part of the process. This includes staying updated on upcoming changes, avoiding civil monetary penalties, drafting better settlement agreements, and learning. Reach out to us today, and we are here to help.